Provider Demographics
NPI:1346437092
Name:SKIN SPECIALISTS OF THE CAPITAL REGION, PLLC
Entity Type:Organization
Organization Name:SKIN SPECIALISTS OF THE CAPITAL REGION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-452-1928
Mailing Address - Street 1:264 WASHINGTON AVENUE EXT STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-6352
Mailing Address - Country:US
Mailing Address - Phone:518-452-1928
Mailing Address - Fax:518-362-1348
Practice Address - Street 1:264 WASHINGTON AVENUE EXT STE 201
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-6352
Practice Address - Country:US
Practice Address - Phone:518-452-1928
Practice Address - Fax:518-708-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1823931207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1823931OtherNYS LICENSE
NYBA0163Medicare PIN
NYE88296Medicare UPIN