Organization
DERMATOLOGIC SURGERY AT CRYSTAL RUN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YEHUDA DAVID ELIEZRI M.D. (PRESIDENT)
(845) 692-3376
Entity
Organization
Contact information
Practice address
7A MEDICAL PARK DR, POMONA, NY 10970-3516
(845) 354-1169
(845) 362-5126
Mailing address
28 RYKOWSKI LN, MIDDLETOWN, NY 10941-4018
(845) 692-3376
(845) 692-0124
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
154268
NY
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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