Provider Demographics
NPI:1689838047
Name:COSMETIC CLINIC DERMATOLOGY
Entity Type:Organization
Organization Name:COSMETIC CLINIC DERMATOLOGY
Other - Org Name:MOUNT SINAI SCHOOL OF MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBWOHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-241-3050
Mailing Address - Street 1:5 E 98TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-3050
Mailing Address - Fax:212-987-1197
Practice Address - Street 1:5 E 98TH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-3050
Practice Address - Fax:212-987-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141913282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital