Provider Demographics
NPI:1639447030
Name:NY COSMETIC SKIN AND LASER SURGERY CENTER
Entity Type:Organization
Organization Name:NY COSMETIC SKIN AND LASER SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROKHSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-512-7616
Mailing Address - Street 1:901 STEWART AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4893
Mailing Address - Country:US
Mailing Address - Phone:516-512-7616
Mailing Address - Fax:516-512-7617
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-512-7616
Practice Address - Fax:516-512-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214852261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH71613Medicare UPIN