Provider Demographics
NPI:1972657948
Name:ADVANCEMENTS IN DERMATOLOGY PL
Entity Type:Organization
Organization Name:ADVANCEMENTS IN DERMATOLOGY PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOTTESFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-572-0299
Mailing Address - Street 1:7730 BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6155
Mailing Address - Country:US
Mailing Address - Phone:561-572-0299
Mailing Address - Fax:561-572-2596
Practice Address - Street 1:7730 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6155
Practice Address - Country:US
Practice Address - Phone:561-572-0299
Practice Address - Fax:561-572-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72007207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16013Medicare PIN
B65559Medicare UPIN