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General NPI Number Information
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NPI Number | 1245651827
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Entity Type | Organization
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Legal Business Name | COMPLETE SKIN & LASER SURGERY PC
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Dates
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Enumeration Date | 12/26/2013
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 225 E 64TH ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10065-6690
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Country | US
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Telephone | 212-759-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 225 E 64TH ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10065-6690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH HALE
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Credential | MD
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Telephone | 917-414-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 215623
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License Number State | NY
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