Provider Demographics
NPI:1336745330
Name:ASSOCIATES IN DERMATOLOGY AND COSMETIC SURGERY-THE MILLBURN LASER CENT
Entity Type:Organization
Organization Name:ASSOCIATES IN DERMATOLOGY AND COSMETIC SURGERY-THE MILLBURN LASER CENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-376-8500
Mailing Address - Street 1:3620 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2038
Mailing Address - Country:US
Mailing Address - Phone:718-792-4700
Mailing Address - Fax:
Practice Address - Street 1:3620 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2038
Practice Address - Country:US
Practice Address - Phone:718-792-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty