Healthcare Provider Details

I. General information

NPI: 1700879079
Provider Name (Legal Business Name): AESTHETIC DERMATOLOGY & COSMETIC SURGERY MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MILLER AVE
MILL VALLEY CA
94941-2905
US

IV. Provider business mailing address

535 MILLER AVE
MILL VALLEY CA
94941-2905
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-5486
  • Fax: 415-389-7455
Mailing address:
  • Phone: 415-383-5486
  • Fax: 415-389-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY H BINSTOCK
Title or Position: OWNER
Credential: MD
Phone: 415-383-5486