Accredited Dermatology, Laser & Cosmetic Surgery, P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

243425 Issued in NY

Legal business name

ACCREDITED DERMATOLOGY, LASER & COSMETIC SURGERY, P.C.

Practice address

2615 E 16TH St
2ND Floor
Brooklyn, NY 11235-3805

Phone

(718) 263-0300

NPI assigned

Jan 28, 2009

Organization subpart

No

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

Authorized official

Name

Yakov DudelzakNPI 1902928997

Title

President

Phone

(718) 263-0300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Yakov Dudelzak, M.D.

  • Dermatology Physician
  • Brooklyn, NY
  • NPI 1902928997
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1233100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233100800000",
    "number": "1285872275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 DONALD LN",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115981516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 E 16TH ST",
            "address_2": "2ND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112353805",
            "telephone_number": "718-263-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCREDITED DERMATOLOGY, LASER & COSMETIC SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-28",
        "last_updated": "2009-01-28",
        "status": "A",
        "authorized_official_last_name": "DUDELZAK",
        "authorized_official_first_name": "YAKOV",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-263-0300"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "243425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.