Basic Information
| Provider Information | |||||||||
| NPI: | 1982871745 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COSMETIC & LASER OBS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 ROSLYN RD | ||||||||
| Address2: | |||||||||
| City: | ROSLYN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115771315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166256222 | ||||||||
| FaxNumber: | 5166216282 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 ROSLYN RD | ||||||||
| Address2: | |||||||||
| City: | ROSLYN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115771315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166256222 | ||||||||
| FaxNumber: | 5166216282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2008 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | LIPPNER | ||||||||
| AuthorizedOfficialFirstName: | LEWIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5163264160 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.