Provider Demographics
NPI:1255593505
Name:LOCKPORT MEDISPA & SKINCARE LLC
Entity type:Organization
Organization Name:LOCKPORT MEDISPA & SKINCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KULWANT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHANGOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-434-4100
Mailing Address - Street 1:5862 S TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-6320
Mailing Address - Country:US
Mailing Address - Phone:716-434-4100
Mailing Address - Fax:716-434-5100
Practice Address - Street 1:5862 S TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6320
Practice Address - Country:US
Practice Address - Phone:716-434-4100
Practice Address - Fax:716-434-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120905208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1371533Medicare UPIN