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General NPI Number Information
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NPI Number | 1952122731
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Entity Type | Organization
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Legal Business Name | SAG HARBOR SKIN AND AESTHETICS LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 34 BAY ST
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City | SAG HARBOR
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State | NY
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Zip | 11963-3104
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Country | US
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Telephone | 212-517-6555
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Fax | 212-472-6796
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Provider Business Mailing Address
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Address Line | 700 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10021-0104
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Country | US
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Telephone | 212-517-6555
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Fax | 212-472-6796
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | MELISSA MALDONADO
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Credential |
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Telephone | 212-517-6555
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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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