Healthcare Provider Details

I. General information

NPI: 1710176607
Provider Name (Legal Business Name): ALICE LASER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

30 WATERSIDE PLZ 20 G
NEW YORK NY
10010-2622
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax:
Mailing address:
  • Phone: 469-222-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number71642
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: