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General NPI Number Information
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NPI Number | 1750666566
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Entity Type | Organization
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Legal Business Name | LASER SURGERY AND COSMETIC DERMATOLOGY CENTERS INC
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 32 PARKING PLZ SUITE 200
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City | ARDMORE
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State | PA
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Zip | 19003-2415
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Country | US
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Telephone | 610-645-5551
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Fax | 610-645-5151
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Provider Business Mailing Address
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Address Line | 32 PARKING PLZ SUITE 200
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City | ARDMORE
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State | PA
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Zip | 19003-2415
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Country | US
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Telephone | 610-645-5551
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Fax | 610-645-5151
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ERIC F. BERNSTEIN
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Credential | M.D.
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Telephone | 610-645-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD432401
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License Number State | PA
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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 | MD045790L
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License Number State | PA
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