Provider Demographics
NPI:1093836298
Name:COSMETIC ASSOCIATES
Entity Type:Organization
Organization Name:COSMETIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:FUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-295-0404
Mailing Address - Street 1:19 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1229
Mailing Address - Country:US
Mailing Address - Phone:516-295-0404
Mailing Address - Fax:516-295-2440
Practice Address - Street 1:19 IRVING PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1229
Practice Address - Country:US
Practice Address - Phone:516-295-0404
Practice Address - Fax:516-295-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145631261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID #