Provider Demographics
NPI:1821009739
Name:LASER AND COSMETIC SURGEONS PC
Entity Type:Organization
Organization Name:LASER AND COSMETIC SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVANDOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-288-1600
Mailing Address - Street 1:1516 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4225
Mailing Address - Country:US
Mailing Address - Phone:570-288-1600
Mailing Address - Fax:570-288-4080
Practice Address - Street 1:1516 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4225
Practice Address - Country:US
Practice Address - Phone:570-288-1600
Practice Address - Fax:570-288-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034037E2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA679035Medicare ID - Type Unspecified