Provider Demographics
NPI:1578606364
Name:SKIN CARE PHYSICIANS LLC
Entity Type:Organization
Organization Name:SKIN CARE PHYSICIANS LLC
Other - Org Name:BOYNTON BEACH SKIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-752-8000
Mailing Address - Street 1:7740 BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3804
Mailing Address - Country:US
Mailing Address - Phone:561-752-8000
Mailing Address - Fax:561-752-8001
Practice Address - Street 1:7740 BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3804
Practice Address - Country:US
Practice Address - Phone:561-752-8000
Practice Address - Fax:561-752-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-12-28
Deactivation Date:2023-12-11
Deactivation Code:
Reactivation Date:2023-12-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL396Medicare PIN