Provider Demographics
NPI:1972610707
Name:DERMATOLOGY LASER AND PLASTIC SURGERY, L.L.P.
Entity type:Organization
Organization Name:DERMATOLOGY LASER AND PLASTIC SURGERY, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMENICO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-433-2424
Mailing Address - Street 1:875 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4942
Mailing Address - Country:US
Mailing Address - Phone:516-433-2424
Mailing Address - Fax:516-433-1065
Practice Address - Street 1:875 OLD COUNTRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4942
Practice Address - Country:US
Practice Address - Phone:516-433-2424
Practice Address - Fax:516-433-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86241Medicare ID - Type Unspecified