Provider Demographics
NPI:1306685995
Name:SKINTRIGUE MEDI SPA INC.
Entity type:Organization
Organization Name:SKINTRIGUE MEDI SPA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RONGO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:631-664-5408
Mailing Address - Street 1:321 DANTE CT STE 18
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3846
Mailing Address - Country:US
Mailing Address - Phone:631-664-5408
Mailing Address - Fax:
Practice Address - Street 1:321 DANTE CT STE 18
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-3846
Practice Address - Country:US
Practice Address - Phone:631-664-5408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty