Provider Demographics
NPI:1396913489
Name:HELENDALE DERMATOLOGY & MEDICAL SPA, PLLC
Entity type:Organization
Organization Name:HELENDALE DERMATOLOGY & MEDICAL SPA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-266-5420
Mailing Address - Street 1:500 HELENDALE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-3109
Mailing Address - Country:US
Mailing Address - Phone:585-266-5420
Mailing Address - Fax:585-266-5423
Practice Address - Street 1:500 HELENDALE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-3109
Practice Address - Country:US
Practice Address - Phone:585-266-5420
Practice Address - Fax:585-266-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199172207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1346219953Medicaid