Provider Demographics
NPI:1902959893
Name:DR DONNA A SERURE, DERMATOLOGY & COSMETIC LASER SURGERY, PC
Entity Type:Organization
Organization Name:DR DONNA A SERURE, DERMATOLOGY & COSMETIC LASER SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SERURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-271-1035
Mailing Address - Street 1:327 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2905
Mailing Address - Country:US
Mailing Address - Phone:631-979-0909
Mailing Address - Fax:631-385-7568
Practice Address - Street 1:327 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2905
Practice Address - Country:US
Practice Address - Phone:631-979-0909
Practice Address - Fax:631-979-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207ND0101X, 207NP0225X, 207NS0135X
NY146291-1207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEH671Medicare ID - Type UnspecifiedGROUP NUMBER