Provider Demographics
NPI:1801258413
Name:DERMATOLOGY LASER GROUP, PLLC.
Entity type:Organization
Organization Name:DERMATOLOGY LASER GROUP, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-444-8204
Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:212-444-8204
Mailing Address - Fax:646-861-6139
Practice Address - Street 1:110 E 60TH STREET
Practice Address - Street 2:SUITE 606
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-444-8204
Practice Address - Fax:646-861-6539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty