Provider Demographics
NPI:1346382710
Name:CENTER FOR DERMATOLOGY, COSMETIC & LASER SURGERY
Entity Type:Organization
Organization Name:CENTER FOR DERMATOLOGY, COSMETIC & LASER SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-241-3003
Mailing Address - Street 1:359 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3028
Mailing Address - Country:US
Mailing Address - Phone:914-241-3003
Mailing Address - Fax:
Practice Address - Street 1:359 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3028
Practice Address - Country:US
Practice Address - Phone:914-241-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1875781207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty