Provider Demographics
NPI:1437597283
Name:HOUSEL DERMATOLOGY, PC
Entity Type:Organization
Organization Name:HOUSEL DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOUSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-452-3376
Mailing Address - Street 1:7293 BUCKLEY RD
Mailing Address - Street 2:SUITE102
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2648
Mailing Address - Country:US
Mailing Address - Phone:315-452-3376
Mailing Address - Fax:315-452-3377
Practice Address - Street 1:7293 BUCKLEY RD
Practice Address - Street 2:SUITE102
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2648
Practice Address - Country:US
Practice Address - Phone:315-452-3376
Practice Address - Fax:315-452-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249753207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty