Provider Demographics
NPI:1417082769
Name:SKIN PATH SERVICES, LLC
Entity Type:Organization
Organization Name:SKIN PATH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-785-7198
Mailing Address - Street 1:10419 CANARY ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2713
Mailing Address - Country:US
Mailing Address - Phone:813-785-7198
Mailing Address - Fax:
Practice Address - Street 1:7641 66TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3173
Practice Address - Country:US
Practice Address - Phone:813-785-7198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71887OtherBLUE CROSS BLUE SHIELD
FL71887OtherBLUE CROSS BLUE SHIELD