Provider Demographics
NPI:1679702740
Name:AESTHETIC AND SURGICAL DERMATOLOGY OF NEW YORK, P.C.
Entity type:Organization
Organization Name:AESTHETIC AND SURGICAL DERMATOLOGY OF NEW YORK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-365-2300
Mailing Address - Street 1:3111 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1217
Mailing Address - Country:US
Mailing Address - Phone:516-365-2300
Mailing Address - Fax:
Practice Address - Street 1:3111 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1217
Practice Address - Country:US
Practice Address - Phone:516-365-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243559207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty