Provider Demographics
NPI:1942628938
Name:NEW ENGLAND LASER AND COSMETIC SURGRY CENTER LLC
Entity Type:Organization
Organization Name:NEW ENGLAND LASER AND COSMETIC SURGRY CENTER LLC
Other - Org Name:NELCSC-ANESTHESIA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-786-7000
Mailing Address - Street 1:PO BOX 11716
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0716
Mailing Address - Country:US
Mailing Address - Phone:518-786-7000
Mailing Address - Fax:518-786-1160
Practice Address - Street 1:1072 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1025
Practice Address - Country:US
Practice Address - Phone:518-786-7000
Practice Address - Fax:518-786-1160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ENGLAND LASER AND COSMETIC SURGERY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical