| NPI | 1609103522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE LEE LAVE Billing/Office Manager 631-265-2928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 083410) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 083410) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 083410) | |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2010-01-27 |