| NPI | 1992982748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH ANDRE MARK Physician 631-283-0002 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 204164) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 204164) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 204164) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2013-04-03 |