Provider Demographics
NPI:1043465602
Name:LASER & MOHS SURGERY OF NEW YORK PLLC
Entity Type:Organization
Organization Name:LASER & MOHS SURGERY OF NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-391-8600
Mailing Address - Street 1:130 W 42ND ST STE 1805
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-7902
Mailing Address - Country:US
Mailing Address - Phone:212-391-8600
Mailing Address - Fax:212-391-8601
Practice Address - Street 1:130 W 42ND ST STE 1805
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7902
Practice Address - Country:US
Practice Address - Phone:212-391-8600
Practice Address - Fax:212-391-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207656305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH05034Medicare UPIN