Provider Demographics
NPI:1932304888
Name:DERMATOLOGY AND COSMETIC CENTER, P.A.
Entity Type:Organization
Organization Name:DERMATOLOGY AND COSMETIC CENTER, P.A.
Other - Org Name:EASTSIDE DERMATOLOGY, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-772-0416
Mailing Address - Street 1:5353 N FEDERAL HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3244
Mailing Address - Country:US
Mailing Address - Phone:954-489-9800
Mailing Address - Fax:
Practice Address - Street 1:5353 N FEDERAL HWY STE 400
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3244
Practice Address - Country:US
Practice Address - Phone:954-489-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8871207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty