Healthcare Provider Details

I. General information

NPI: 1053303826
Provider Name (Legal Business Name): NEW ENGLAND LASER AND COSMETIC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 TROY SCHENECTADY RD
LATHAM NY
12110-1025
US

IV. Provider business mailing address

PO BOX 11716 NELSC
ALBANY NY
12211-0716
US

V. Phone/Fax

Practice location:
  • Phone: 518-783-0035
  • Fax:
Mailing address:
  • Phone: 518-786-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWIN F WILLIAMS III
Title or Position: MANAGING EMPLOYEE/OWNER
Credential: MD
Phone: 518-786-7000