Provider Demographics
NPI:1821125956
Name:AESTHETIC DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:AESTHETIC DERMATOLOGY, LLC
Other - Org Name:CENTER FOR AESTHETIC DERMATOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-496-9400
Mailing Address - Street 1:800 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2503
Mailing Address - Country:US
Mailing Address - Phone:516-496-3400
Mailing Address - Fax:516-496-9212
Practice Address - Street 1:800 WOODBURY RD STE A
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2503
Practice Address - Country:US
Practice Address - Phone:516-496-9400
Practice Address - Fax:516-496-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZWTX1Medicare UPIN