Provider Demographics
NPI:1083659569
Name:ASSOCIATED SKIN CARE SPECIALISTS, PA
Entity Type:Organization
Organization Name:ASSOCIATED SKIN CARE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:POGORELEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-502-2937
Mailing Address - Street 1:119 14TH ST NW STE 240
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-0007
Mailing Address - Country:US
Mailing Address - Phone:763-571-4000
Mailing Address - Fax:763-502-2966
Practice Address - Street 1:3833 COON RAPIDS BLVD NW STE 280
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2597
Practice Address - Country:US
Practice Address - Phone:763-571-4000
Practice Address - Fax:763-502-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC00306Medicare ID - Type Unspecified