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General NPI Number Information
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NPI Number | 1184735193
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Entity Type | Organization
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Legal Business Name | MASSAPEQUA DERMATOLOGY PLLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 70 GRAND AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4906
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Country | US
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Telephone | 516-799-1600
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Fax | 516-799-1454
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Provider Business Mailing Address
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Address Line | 70 GRAND AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4906
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Country | US
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Telephone | 516-799-1600
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Fax | 516-799-1454
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID B KESSLER
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Credential | D.O.
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Telephone | 516-799-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 171086
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License Number State | NY
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