Healthcare Provider Details

I. General information

NPI: 1811032196
Provider Name (Legal Business Name): ADVANCED DERMATOLOGY LASER AND COSMETIC SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 AVENUE P
BROOKLYN NY
11229-1009
US

IV. Provider business mailing address

1220 AVENUE P
BROOKLYN NY
11229-1009
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-7546
  • Fax: 718-376-6475
Mailing address:
  • Phone: 718-375-7546
  • Fax: 718-376-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: EYAL K LEVIT
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-375-7546