Provider Demographics
NPI:1407133440
Name:SEAVIEW SKIN CANCER SURGERY, LLC
Entity Type:Organization
Organization Name:SEAVIEW SKIN CANCER SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOHS SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-995-2967
Mailing Address - Street 1:256 MASON AVE # C
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3408
Mailing Address - Country:US
Mailing Address - Phone:718-226-1251
Mailing Address - Fax:718-226-1252
Practice Address - Street 1:256 MASON AVE # C
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:718-226-1251
Practice Address - Fax:718-226-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201613-1261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty