Provider Demographics
NPI:1881431633
Name:SKIN SECRETS WELLNESS PC
Entity type:Organization
Organization Name:SKIN SECRETS WELLNESS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-582-8015
Mailing Address - Street 1:70 PARK AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1239
Mailing Address - Country:US
Mailing Address - Phone:201-582-8015
Mailing Address - Fax:201-277-4372
Practice Address - Street 1:70 PARK AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1239
Practice Address - Country:US
Practice Address - Phone:201-582-8015
Practice Address - Fax:201-277-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty