Provider Demographics
NPI:1710987227
Name:COSMETIQUE DERMATOLOGY, LASER & PLASTIC SURGERY, LLP
Entity Type:Organization
Organization Name:COSMETIQUE DERMATOLOGY, LASER & PLASTIC SURGERY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-484-9000
Mailing Address - Street 1:31 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1320
Mailing Address - Country:US
Mailing Address - Phone:516-484-9000
Mailing Address - Fax:516-484-7549
Practice Address - Street 1:31 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1320
Practice Address - Country:US
Practice Address - Phone:516-484-9000
Practice Address - Fax:516-484-7549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146515207ND0101X
NY147060-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXWPW1Medicare PIN