Provider Demographics
NPI:1043832645
Name:ANEWGLOW DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:ANEWGLOW DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-327-5679
Mailing Address - Street 1:PO BOX 130312
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-0991
Mailing Address - Country:US
Mailing Address - Phone:626-327-5679
Mailing Address - Fax:
Practice Address - Street 1:86 BOWERY FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4615
Practice Address - Country:US
Practice Address - Phone:212-226-4890
Practice Address - Fax:212-226-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty