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General NPI Number Information
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NPI Number | 1639447030
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Entity Type | Organization
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Legal Business Name | NY COSMETIC SKIN AND LASER SURGERY CENTER
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 901 STEWART AVE SUITE 240
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City | GARDEN CITY
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State | NY
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Zip | 11530-4893
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Country | US
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Telephone | 516-512-7616
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Fax | 516-512-7617
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Provider Business Mailing Address
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Address Line | 901 STEWART AVE SUITE 240
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City | GARDEN CITY
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State | NY
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Zip | 11530-4893
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Country | US
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Telephone | 516-512-7616
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Fax | 516-512-7617
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. CAMERON K ROKHSAR
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Credential | M.D.
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Telephone | 516-512-7616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 214852
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License Number State | NY
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