Provider Demographics
NPI:1922872662
Name:SKYLIGHT PSYCHEDELICS, LLC
Entity Type:Organization
Organization Name:SKYLIGHT PSYCHEDELICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-982-4809
Mailing Address - Street 1:30 RIVEREDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-3212
Mailing Address - Country:US
Mailing Address - Phone:917-446-6829
Mailing Address - Fax:646-349-4435
Practice Address - Street 1:30 RIVEREDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-3212
Practice Address - Country:US
Practice Address - Phone:917-446-6829
Practice Address - Fax:646-349-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty