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General NPI Number Information
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NPI Number | 1023200722
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Entity Type | Organization
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Legal Business Name | FINGER LAKES DERMATOLOGY
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 100 GENESEE ST SUITE 108
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City | AUBURN
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State | NY
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Zip | 13021-3642
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Country | US
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Telephone | 315-252-7539
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Fax | 315-252-3885
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Provider Business Mailing Address
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Address Line | 144 STANDART AVE
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City | AUBURN
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State | NY
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Zip | 13021-1508
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Country | US
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Telephone | 315-255-1100
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Fax | 315-255-1322
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANGELA ASH
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Credential |
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Telephone | 315-255-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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