Provider Demographics
NPI:1982871745
Name:COSMETIC & LASER OBS PC
Entity Type:Organization
Organization Name:COSMETIC & LASER OBS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-326-4160
Mailing Address - Street 1:165 ROSLYN RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1315
Mailing Address - Country:US
Mailing Address - Phone:516-625-6222
Mailing Address - Fax:516-621-6282
Practice Address - Street 1:165 ROSLYN RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1315
Practice Address - Country:US
Practice Address - Phone:516-625-6222
Practice Address - Fax:516-621-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical