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General NPI Number Information
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NPI Number | 1043465602
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Entity Type | Organization
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Legal Business Name | LASER & MOHS SURGERY OF NEW YORK PLLC
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 130 W 42ND ST STE 1805
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City | NEW YORK
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State | NY
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Zip | 10036-7902
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Country | US
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Telephone | 212-391-8600
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Fax | 212-391-8601
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Provider Business Mailing Address
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Address Line | 130 W 42ND ST STE 1805
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City | NEW YORK
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State | NY
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Zip | 10036-7902
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Country | US
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Telephone | 212-391-8600
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Fax | 212-391-8601
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADELLE T QUINTANA
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Credential | M.D.
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Telephone | 212-391-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 207656
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License Number State | NY
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