Provider Demographics
NPI:1427343391
Name:SKIN CANCER AND AESTHETIC SURGERY, P.C.
Entity type:Organization
Organization Name:SKIN CANCER AND AESTHETIC SURGERY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VERGILIS-KALNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-531-6041
Mailing Address - Street 1:35 SEACOAST TER
Mailing Address - Street 2:SUITE 18M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6040
Mailing Address - Country:US
Mailing Address - Phone:917-531-6041
Mailing Address - Fax:
Practice Address - Street 1:2727 OCEAN PKWY
Practice Address - Street 2:SUITE L1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7857
Practice Address - Country:US
Practice Address - Phone:718-975-7546
Practice Address - Fax:718-975-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-18
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256563207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03348170Medicaid