Provider Demographics
NPI:1407374481
Name:CENTER FOR SKIN SURGERY & DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:CENTER FOR SKIN SURGERY & DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-676-1900
Mailing Address - Street 1:2928 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1007
Mailing Address - Country:US
Mailing Address - Phone:860-633-2332
Mailing Address - Fax:860-633-2352
Practice Address - Street 1:2928 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1007
Practice Address - Country:US
Practice Address - Phone:860-633-2332
Practice Address - Fax:860-633-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040694207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT040694OtherMEDICAL LICENSE
1790888584OtherNPI
FC2314881OtherDEA