Provider Demographics
NPI:1053303826
Name:NEW ENGLAND LASER AND COSMETIC SURGERY CENTER LLC
Entity type:Organization
Organization Name:NEW ENGLAND LASER AND COSMETIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:518-786-7000
Mailing Address - Street 1:PO BOX 11716
Mailing Address - Street 2:NELSC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0716
Mailing Address - Country:US
Mailing Address - Phone:518-786-7000
Mailing Address - Fax:
Practice Address - Street 1:1072 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1025
Practice Address - Country:US
Practice Address - Phone:518-783-0035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0153203ROtherOPERATING CERT NUMBER
NY0153203ROtherOPERATING CERT NUMBER