Provider Demographics
NPI:1144855172
Name:YOUNG SKIN, P.A.
Entity type:Organization
Organization Name:YOUNG SKIN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-821-1331
Mailing Address - Street 1:11076 MERIDIAN DR N
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4592
Mailing Address - Country:US
Mailing Address - Phone:954-821-1331
Mailing Address - Fax:
Practice Address - Street 1:5200 S UNIVERSITY DR STE 102
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5316
Practice Address - Country:US
Practice Address - Phone:954-242-4275
Practice Address - Fax:954-530-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty