Provider profile · NPI 1154004133

1091 Southern Blvd Dermatology Pllc

Dermatology · Bronx, NY · NPI 1154004133 · No federal exclusion match

✔ Verified against the public CMS NPPES registry & HHS-OIG LEIE as of Jun 21, 2026. Source-linked, daily-refreshed. Public data only — no PHI.

Registry details

Type

Organization

Primary specialty

Dermatology

Enumerated

Aug 8, 2023

License(s)

Addresses on file

PurposeAddressCity/StatePhone
LOCATION1091 SOUTHERN BLVD Bronx, NY 10459-2417718-401-7000
MAILING4037 74TH ST Elmhurst, NY 11373-5603347-642-9802

View on NPPES registry ↗

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