NPIMap

Organization Active NPI

East Side Dermatology Services PC

  • MOHS-Micrographic Surgery Physician
  • New York, NY
National Provider Identifier
1023063906
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
EAST SIDE DERMATOLOGY SERVICES PC
Practice address
317 East 34TH Street
11 Floor
New York, NY 10016-4996
Phone
(212) 686-7306
Fax
(212) 686-7305
NPI assigned
May 23, 2006
Reactivated
Jul 17, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Roy S Seidenberg, M.DNPI 1225094725
Title
Medical Director
Phone
(212) 686-7306

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X Primary

Addresses

Primary practice location

317 East 34TH Street
11 Floor
New York, NY 10016-4996

Mailing address

PO Box 24904
New York, NY 10087-4904
Phone (212) 686-7306

Other names 1

  • LASER & SKIN SURGERY CENTER OF NEW YORK Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040809001445 NY Part B Supplier - Clinic/Group Practice 5294707352 Receives reassigned benefits from 3 practitioners
Practice locations: New York, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754352000000",
    "number": "1023063906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24904",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100874904",
            "telephone_number": "212-686-7306",
            "fax_number": "212-686-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 EAST 34TH STREET",
            "address_2": "11 FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164996",
            "telephone_number": "212-686-7306",
            "fax_number": "212-686-7305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST SIDE DERMATOLOGY SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "deactivation_date": "2025-06-24",
        "reactivation_date": "2025-07-17",
        "status": "A",
        "authorized_official_last_name": "SEIDENBERG",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "212-686-7306",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LASER & SKIN SURGERY CENTER OF NEW YORK",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LASER & SKIN SURGERY CENTER OF NEW YORK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.