Organization
MARIWALLA DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAVITA MARIWALLA MD (OWNER)
(631) 665-3376
Entity
Organization
Contact information
Practice address
1253 MONTAUK HWY, WEST ISLIP, NY 11795-4916
(631) 665-3376
(631) 969-3376
Mailing address
1253 MONTAUK HWY, WEST ISLIP, NY 11795-4916
(631) 665-3376
(631) 969-3376
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Enumeration date
03/23/2011
Last updated
04/20/2017
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