Provider Demographics
NPI:1598225260
Name:DERMATOLOGY LASER AND SURGERY OF CARNEGIE HILL PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY LASER AND SURGERY OF CARNEGIE HILL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASORSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-982-8229
Mailing Address - Street 1:1095 PARK AVE # 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1154
Mailing Address - Country:US
Mailing Address - Phone:212-982-8229
Mailing Address - Fax:646-792-3301
Practice Address - Street 1:1095 PARK AVE STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1154
Practice Address - Country:US
Practice Address - Phone:212-982-8229
Practice Address - Fax:646-792-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1558403121OtherNPI
NY1578723433OtherNPI