BRIDGEVIEW DERMATOLOGY, PLLC
Complete NPI Record 1003349986
Dermatology - Procedural Dermatology in Staten Island, NY
Active since April 06, 2017CLIA 33D2198342 · Certificate of Compliance
Complete NPI Dataset
This page contains the complete raw NPPES record for Bridgeview Dermatology, Pllc (NPI 1003349986), a dermatology organization in Staten Island, NY. All 38 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1003349986 Field 1/38
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/38
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/38
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: BRIDGEVIEW DERMATOLOGY, PLLC Field 4/38
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 2955 VETERANS RD W STE 2F Field 5/38
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: STATEN ISLAND Field 6/38
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: NY Field 7/38
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 103092504 Field 8/38
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/38
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 9292003003 Field 10/38
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 9292240696 Field 11/38
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 2955 VETERANS RD W STE 2F Field 12/38
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: STATEN ISLAND Field 13/38
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: NY Field 14/38
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 103092504 Field 15/38
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/38
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 9292003003 Field 17/38
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 9292240696 Field 18/38
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: PATEL Field 21/38
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: TEJAS Field 22/38
- The first name of the authorized official.
- Authorized Official Title or Position: PRESIDENT Field 23/38
- The title or position of the authorized official.
- Authorized Official Telephone Number: 9292003003 Field 24/38
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207ND0101X Field 25/38
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: 282042- Field 26/38
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: NY Field 27/38
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 28/38
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 207NS0135X Field 29/38
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 2: 282042-1 Field 30/38
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 2: NY Field 31/38
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 32/38
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 33/38
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Authorized Official Name Prefix Text: DR. Field 34/38
- The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
- Authorized Official Credential Text: MD Field 35/38
- The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
- Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP Field 36/38
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP Field 37/38
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Secondary Practice Locations 18
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
1041 E 83rd St Unit 2F
Location 1/18Brooklyn, NY 11236-4225 · Phone (929) 200-3003
431 Beach 20th St
Location 2/18Far Rockaway, NY 11691-3621 · Phone (929) 200-3003
14040 Sanford Ave
Location 3/18Flushing, NY 11355-2556 · Phone (929) 200-3003
1740 Express Dr S
Location 4/18Hauppauge, NY 11788-5302 · Phone (929) 200-3003
211 Lake Shore Rd
Location 5/18Lake Ronkonkoma, NY 11779-3192 · Phone (929) 200-3003
1526 New Haven Ave
Location 6/18Far Rockaway, NY 11691-5148 · Phone (929) 200-3003
110 Henderson Ave
Location 7/18Staten Island, NY 10301-2108 · Phone (929) 200-3003
130 Lake Ave S
Location 8/18Nesconset, NY 11767-1001 · Phone (929) 200-3003
143 E Main St
Location 9/18Babylon, NY 11702-3524 · Phone (929) 200-3003
1509 Central Ave
Location 10/18Far Rockaway, NY 11691-4001 · Phone (929) 200-3003
70 Father Capodanno Blvd
Location 11/18Staten Island, NY 10305-4803 · Phone (929) 200-3003
1350 Route 112
Location 12/18Port Jefferson Station, NY 11776-3078 · Phone (929) 200-3003
8008 45th Ave Unit 2F
Location 13/18Elmhurst, NY 11373-3545 · Phone (929) 200-3003
3010 W 33rd St
Location 14/18Brooklyn, NY 11224-1404 · Phone (929) 200-3003
1800 Waring Ave
Location 15/18Bronx, NY 10469-6331 · Phone (929) 200-3003
11502 Ocean Promenade
Location 16/18Rockaway Park, NY 11694-2412 · Phone (929) 200-3003
799 E Gun Hill Rd
Location 17/18Bronx, NY 10467-6107 · Phone (929) 200-3003
6355 Broadway
Location 18/18Bronx, NY 10471-2701 · Phone (929) 200-3003
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