Advanced Dermatology of Coop City PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

ADVANCED DERMATOLOGY OF COOP CITY PC

Practice address

2100 Bartow Ave
Suite 211
Bronx, NY 10475-4614

Phone

(718) 671-1000

Fax

(212) 765-3210

NPI assigned

Oct 19, 2010

Organization subpart

No

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

Authorized official

Name

Lawrence D Jaeger, D.O

Title

Medical Director

Phone

(212) 262-2500

Specialties & licenses 1

Addresses

Other names 1

• Advanced Dermatology Associates Doing business as

Locations

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287446400000",
    "number": "1811207210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CENTRAL PARK S",
            "address_2": "SUITE 107",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191436",
            "telephone_number": "212-262-2500",
            "fax_number": "212-765-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 BARTOW AVE",
            "address_2": "SUITE 211",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104754614",
            "telephone_number": "718-671-1000",
            "fax_number": "212-765-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF COOP CITY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-19",
        "last_updated": "2010-10-19",
        "status": "A",
        "authorized_official_last_name": "JAEGER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "212-262-2500",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Advance Primary Specialty Care
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• Advanced Bronx Dental PLLC
• Advanced Chiropractic of Pelham Bay P.C.
• Advanced Dermatology of New York PC
• Advanced Dermatology of New York PC
• Advanced Dermatology of New York, P.C.
• Advanced Dermatology of New York, PC
• Advanced Dermatology of the Bronx PC

• Specialist in Bronx, NY
• Providers in Bronx, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.