Accredited Dermatologic Surgery, PC

Key facts

NPI

1992208144

Entity type

Organization (NPI type 2)

Primary specialty

Ambulatory Surgical Clinic/Center 261QA1903X

License

6417 (NY)

Legal business name

ACCREDITED DERMATOLOGIC SURGERY, PC

Practice address

23-83 Bell Blvd
Bayside, NY 11360

Phone

(718) 423-0200

NPI assigned

Mar 14, 2018

Organization subpart

No

Authorized official

Name

Jordan S. Zuckerman, MD NPI 1043205016

Title

Medical Director

Phone

(718) 423-0200

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

Practitioners 1

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

• Jordan Spence Zuckerman, M.D. Procedural Dermatology Physician · Bayside, NY · NPI 1043205016
  NPD Authorized official

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 14, 2018.

{
    "created_epoch": "1520985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520985600000",
    "number": "1992208144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23-83 BELL BLVD",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "11360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23-83 BELL BLVD",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "11360",
            "telephone_number": "718-423-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCREDITED DERMATOLOGIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-14",
        "last_updated": "2018-03-14",
        "status": "A",
        "authorized_official_last_name": "ZUCKERMAN",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "718-423-0200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "6417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ASSOCIATION FOR ACCREDITATION OF AMBULATORY FACILITIES, INC.",
            "identifier": "6417",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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