Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

1091 Southern Blvd Dermatology PLLC

Organization Dermatology Physician · NPI 1154004133

1091 Southern Blvd Dermatology PLLC is a Dermatology Physician in Bronx, New York. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1091 Southern Blvd
Bronx, NY 10459-2417
Phone: (718) 401-7000
Fax: (917) 473-7878
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1154004133
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Wendy Sanchez — Office Manager · (347) 642-9802
NPI enumeratedAugust 8, 2023
Last updated in NPPESAugust 8, 2023
Certification dateAugust 8, 2023
Mailing address4037 74th St, Elmhurst, NY 11373-5603

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