Provider Demographics
NPI:1275589558
Name:SOUTHERN TIER DERMATOLOGY & AESTHETICS
Entity Type:Organization
Organization Name:SOUTHERN TIER DERMATOLOGY & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAR.
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFTENANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-729-2777
Mailing Address - Street 1:333 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760
Mailing Address - Country:US
Mailing Address - Phone:607-729-2776
Mailing Address - Fax:
Practice Address - Street 1:333 HOOPER RD.
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760
Practice Address - Country:US
Practice Address - Phone:607-729-2776
Practice Address - Fax:607-729-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty