Provider Demographics
NPI:1487727103
Name:SADICK AESTHETIC SURGERY AND DERMATOLOGY, PC
Entity type:Organization
Organization Name:SADICK AESTHETIC SURGERY AND DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-772-7242
Mailing Address - Street 1:911 PARK AVE
Mailing Address - Street 2:STE #1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0385
Mailing Address - Country:US
Mailing Address - Phone:212-772-7242
Mailing Address - Fax:212-517-9566
Practice Address - Street 1:911 PARK AVE
Practice Address - Street 2:STE #1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0385
Practice Address - Country:US
Practice Address - Phone:212-772-7242
Practice Address - Fax:212-517-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100016191Medicare PIN
NYA64072Medicare UPIN