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General NPI Number Information
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NPI Number | 1922872662
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Entity Type | Organization
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Legal Business Name | SKYLIGHT PSYCHEDELICS, LLC
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 30 RIVEREDGE RD STE 2
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City | TENAFLY
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State | NJ
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Zip | 07670-3212
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Country | US
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Telephone | 917-446-6829
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Fax | 646-349-4435
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Provider Business Mailing Address
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Address Line | 30 RIVEREDGE RD STE 2
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City | TENAFLY
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State | NJ
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Zip | 07670-3212
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Country | US
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Telephone | 917-446-6829
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Fax | 646-349-4435
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANA LERMAN
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Credential | MD
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Telephone | 646-982-4809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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