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Organization
DERMATOLOGY & PLASTIC SURGERY OF NORTHERN NEW YORK PC
Active
Organization
DERMATOLOGY & PLASTIC SURGERY OF NORTHERN NEW YORK PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARBARA LICZNERSKI MD (PRESIDENT)
(315) 786-1500
Entity
Organization
Contact information
Practice address
826 WASHINGTON STREET, SUITE 104, WATERTOWN, NY 13601-4065
(315) 786-1500
Mailing address
PO BOX 91, WATERTOWN, NY 13601-0091
(315) 782-4207
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA0167
GROUP NUMBER
NY
Enumeration date
10/05/2006
Last updated
02/18/2009
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