Provider Demographics
NPI:1730956855
Name:PREMIER DERMATOLOGY ASSOCIATES, INC
Entity type:Organization
Organization Name:PREMIER DERMATOLOGY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARKADY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALYUZHNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-804-4553
Mailing Address - Street 1:214 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4117
Mailing Address - Country:US
Mailing Address - Phone:917-804-4553
Mailing Address - Fax:917-975-6272
Practice Address - Street 1:825 CORAL RIDGE DR
Practice Address - Street 2:CARDIOVASCULAR SUITES
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4180
Practice Address - Country:US
Practice Address - Phone:305-810-8846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty