Healthcare Provider Details

I. General information

NPI: 1902959893
Provider Name (Legal Business Name): DR DONNA A SERURE, DERMATOLOGY & COSMETIC LASER SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 02/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E MAIN ST
SMITHTOWN NY
11787-2905
US

IV. Provider business mailing address

327 E MAIN ST
SMITHTOWN NY
11787-2905
US

V. Phone/Fax

Practice location:
  • Phone: 631-979-0909
  • Fax: 631-979-0455
Mailing address:
  • Phone: 631-979-0909
  • Fax: 631-385-7568

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 Number146291-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID A. SERURE
Title or Position: CEO
Credential:
Phone: 631-271-1035