Provider Demographics
NPI:1538100987
Name:SKIN LASER AND SURGERY SPECIALISTS OF NY/NJ, LLC
Entity Type:Organization
Organization Name:SKIN LASER AND SURGERY SPECIALISTS OF NY/NJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-594-9901
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 702
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:201-441-9890
Mailing Address - Fax:201-441-9893
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 702
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-441-9890
Practice Address - Fax:201-441-9893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWLW891Medicare PIN
NJ101476Medicare PIN