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General NPI Number Information
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NPI Number | 1275589558
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Entity Type | Organization
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Legal Business Name | SOUTHERN TIER DERMATOLOGY & AESTHETICS
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 333 HOOPER RD.
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City | ENDWELL
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State | NY
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Zip | 13760
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Country | US
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Telephone | 607-729-2776
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Fax | 607-729-2773
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Provider Business Mailing Address
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Address Line | 333 HOOPER RD
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City | ENDWELL
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State | NY
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Zip | 13760
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Country | US
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Telephone | 607-729-2776
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Fax |
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Authorized Official
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Title or Position | MAR.
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Name | NANCY LEFTENANT
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Credential |
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Telephone | 607-729-2777
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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 |
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License Number State |
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