Provider Demographics
NPI:1790526812
Name:THE DERM COLLECTIVE NORTH SHORE, PLLC
Entity type:Organization
Organization Name:THE DERM COLLECTIVE NORTH SHORE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:NEEMS
Authorized Official - Last Name:PRITZKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-942-2204
Mailing Address - Street 1:40 SKOKIE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1618
Mailing Address - Country:US
Mailing Address - Phone:847-942-2204
Mailing Address - Fax:
Practice Address - Street 1:40 SKOKIE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1618
Practice Address - Country:US
Practice Address - Phone:847-942-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty