| NPI | 1003978669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIMI G BANSAL Owner 516-352-2700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 2122661) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |