Provider Demographics
NPI:1972970036
Name:SKIN AND RADIATION SPECIALISTS PLLC
Entity type:Organization
Organization Name:SKIN AND RADIATION SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENU
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-578-1226
Mailing Address - Street 1:55 ORCHARD CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2801
Mailing Address - Country:US
Mailing Address - Phone:516-367-3371
Mailing Address - Fax:
Practice Address - Street 1:6513 PRESTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2694
Practice Address - Country:US
Practice Address - Phone:972-403-9777
Practice Address - Fax:972-403-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH97452085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty