Provider Demographics
NPI:1932880788
Name:ELEVATE DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:ELEVATE DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-575-5306
Mailing Address - Street 1:66 COMMACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3405
Mailing Address - Country:US
Mailing Address - Phone:631-481-7470
Mailing Address - Fax:
Practice Address - Street 1:66 COMMACK RD STE 200
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3405
Practice Address - Country:US
Practice Address - Phone:631-481-7470
Practice Address - Fax:631-623-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty