Provider Demographics
NPI:1598461071
Name:THE DERM GROUP LLP
Entity Type:Organization
Organization Name:THE DERM GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GIUFFRIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-461-2000
Mailing Address - Street 1:11924 FOREST HILL BLVD STE 10A-411
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6256
Mailing Address - Country:US
Mailing Address - Phone:786-648-4431
Mailing Address - Fax:786-648-4432
Practice Address - Street 1:1036 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4417
Practice Address - Country:US
Practice Address - Phone:305-227-9233
Practice Address - Fax:305-245-5105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DERM GROUP LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105703400Medicaid