Provider Demographics
NPI:1720259443
Name:DERMATOLOGY &COSMETIC CENTER OF ROCHESTER
Entity type:Organization
Organization Name:DERMATOLOGY &COSMETIC CENTER OF ROCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-544-7000
Mailing Address - Street 1:1338 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2018
Mailing Address - Country:US
Mailing Address - Phone:585-544-7000
Mailing Address - Fax:585-544-7080
Practice Address - Street 1:1338 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2018
Practice Address - Country:US
Practice Address - Phone:585-544-7000
Practice Address - Fax:585-544-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190014207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1338Medicare PIN