Provider Demographics
NPI:1437214210
Name:BETTER SKIN DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:BETTER SKIN DERMATOLOGY, LLC
Other - Org Name:DMITRY KHASAK, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-626-4040
Mailing Address - Street 1:PO BOX 6656
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10150-6656
Mailing Address - Country:US
Mailing Address - Phone:201-626-4040
Mailing Address - Fax:201-626-4041
Practice Address - Street 1:100 PAVONIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-2778
Practice Address - Country:US
Practice Address - Phone:201-626-4040
Practice Address - Fax:201-626-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06377000174400000X
NY1194054174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty