Organization
ADVANCED DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIS LIPPNER (ADMINISTRATOR)
(516) 326-4160
Entity
Organization
Contact information
Practice address
510 MONTAUK HWY, WEST ISLIP, NY 11795-4422
(631) 587-1132
(631) 422-4922
Mailing address
6 LOWELL AVE, NEW HYDE PARK, NY 11040-2810
(516) 326-4160
(516) 437-0482
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Enumeration date
05/06/2008
Last updated
05/06/2008
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