Provider Demographics
NPI:1841559606
Name:SKIN CANCER CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:SKIN CANCER CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-775-6011
Mailing Address - Street 1:4601 MILITARY TRL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4834
Mailing Address - Country:US
Mailing Address - Phone:561-775-6011
Mailing Address - Fax:561-775-6044
Practice Address - Street 1:4601 MILITARY TRL
Practice Address - Street 2:SUITE 203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4834
Practice Address - Country:US
Practice Address - Phone:561-775-6011
Practice Address - Fax:561-775-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85020207ND0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty