Organization
CLOUDLAKE DERMATOLOGY PLLC
Active
Organization
CLOUDLAKE DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARIKA BANKER MD (OWNER)
(516) 992-6350
Entity
Organization
Contact information
Practice address
400 N BROADWAY, JERICHO, NY 11753-2113
(516) 992-6350
Mailing address
400 N BROADWAY, JERICHO, NY 11753-2113
(516) 992-6350
(516) 992-6346
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
263656-1
NY
Other
Enumeration date
10/10/2016
Last updated
11/20/2017
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