Provider Demographics
NPI:1457583312
Name:ADVANCED MEDICAL AND DERM AESTHETICS
Entity Type:Organization
Organization Name:ADVANCED MEDICAL AND DERM AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-994-2632
Mailing Address - Street 1:PO BOX 811870
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33481-1870
Mailing Address - Country:US
Mailing Address - Phone:561-994-2632
Mailing Address - Fax:
Practice Address - Street 1:4640 HYPOLUXO RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7534
Practice Address - Country:US
Practice Address - Phone:561-296-1715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty