Provider Demographics
NPI:1447453170
Name:DERMATOLOGY & SKIN SURGERY CENTER OF YORK, LLC
Entity type:Organization
Organization Name:DERMATOLOGY & SKIN SURGERY CENTER OF YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:IVANA
Authorized Official - Last Name:BENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-755-4422
Mailing Address - Street 1:400 PINE GROVE CMNS
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5161
Mailing Address - Country:US
Mailing Address - Phone:717-755-4422
Mailing Address - Fax:717-755-2390
Practice Address - Street 1:400 PINE GROVE CMNS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5161
Practice Address - Country:US
Practice Address - Phone:717-755-4422
Practice Address - Fax:717-755-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I01737Medicare UPIN
076834Medicare ID - Type Unspecified