Provider Demographics
NPI:1083066450
Name:ARIZONA SKIN AND LASER THERAPY INSTITUE, LTD
Entity Type:Organization
Organization Name:ARIZONA SKIN AND LASER THERAPY INSTITUE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUPERFON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-277-1449
Mailing Address - Street 1:2224 W. NORTHERN AVE.
Mailing Address - Street 2:SUITE D-300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5099
Mailing Address - Country:US
Mailing Address - Phone:602-277-1449
Mailing Address - Fax:602-277-9984
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:SUITE C-3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3348
Practice Address - Country:US
Practice Address - Phone:602-396-0851
Practice Address - Fax:602-841-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty