Provider Demographics
NPI:1023200722
Name:FINGER LAKES DERMATOLOGY
Entity Type:Organization
Organization Name:FINGER LAKES DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-255-1100
Mailing Address - Street 1:144 STANDART AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1508
Mailing Address - Country:US
Mailing Address - Phone:315-255-1100
Mailing Address - Fax:315-255-1322
Practice Address - Street 1:100 GENESEE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3642
Practice Address - Country:US
Practice Address - Phone:315-252-7539
Practice Address - Fax:315-252-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1616Medicare PIN
NY56625AMedicare PIN