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General NPI Number Information
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NPI Number | 1093782492
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Entity Type | Organization
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Legal Business Name | SOHO SKIN AND LASER DERMATOLOGY PC
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 197 GRAND ST STE 3E
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City | NEW YORK
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State | NY
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Zip | 10013-3859
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Country | US
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Telephone | 212-431-7600
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Fax | 212-431-7521
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Provider Business Mailing Address
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Address Line | 347 MOUNT PLEASANT AVE STE 205
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2749
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Country | US
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Telephone | 973-571-2121
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Fax | 973-498-0569
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Authorized Official
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Title or Position | CEO
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Name | DR. SIMON SAMAHA
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Credential | M.D.
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Telephone | 973-571-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | NY165531
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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