Provider Demographics
NPI:1700221652
Name:JUNO DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:JUNO DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHTUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-594-0050
Mailing Address - Street 1:3801 PGA BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3801 PGA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2758
Practice Address - Country:US
Practice Address - Phone:561-594-0050
Practice Address - Fax:888-677-3527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty