Provider Demographics
NPI:1851595094
Name:LONG ISLAND SKIN CANCER & DERMATOLOGIC SURGERY, PC
Entity Type:Organization
Organization Name:LONG ISLAND SKIN CANCER & DERMATOLOGIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-864-6647
Mailing Address - Street 1:994 W JERICHO TPKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3235
Mailing Address - Country:US
Mailing Address - Phone:631-864-6647
Mailing Address - Fax:631-864-6001
Practice Address - Street 1:994 W JERICHO TPKE
Practice Address - Street 2:SUITE 103
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3235
Practice Address - Country:US
Practice Address - Phone:631-864-6647
Practice Address - Fax:631-864-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI24844Medicare UPIN
NY60F111Medicare PIN
NY2K7991Medicare PIN
NY3K4531Medicare PIN
NYB57924Medicare UPIN
NYH74136Medicare UPIN
NYWEX411Medicare PIN