MEDICARE: SKIN CANCER AND AESTHETIC SURGERY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	256563	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427343391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKIN CANCER AND AESTHETIC SURGERY, P.C.

Provider Business Mailing Address
First Line	:	35 SEACOAST TER
Second Line	:	SUITE 18M
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6040
Country	:	US
Telephone Number	:	917-531-6041
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 OCEAN PKWY
Second Line	:	SUITE L1
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7857
Country	:	US
Telephone Number	:	718-975-7546
Fax Number	:	718-975-7547

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IRENE J VERGILIS-KALNER
Credential	:	M.D.
Telephone Number	:	917-531-6041

Provider Enumeration Date	:	06/18/2011
Last Update Date	:	05/06/2015

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