Healthcare Provider Details

I. General information

NPI: 1598225260
Provider Name (Legal Business Name): DERMATOLOGY LASER AND SURGERY OF CARNEGIE HILL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 PARK AVE STE 1A
NEW YORK NY
10128-1154
US

IV. Provider business mailing address

1095 PARK AVE # 1A
NEW YORK NY
10128-1154
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-8229
  • Fax: 646-792-3301
Mailing address:
  • Phone: 212-982-8229
  • Fax: 646-792-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGELA LASORSA
Title or Position: MANAGER
Credential:
Phone: 212-982-8229