Provider Demographics
NPI:1417764523
Name:VIVASKIN DERMATOLOGY SURGERY CENTER, PLLC
Entity type:Organization
Organization Name:VIVASKIN DERMATOLOGY SURGERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HYEMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POMERANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-261-0085
Mailing Address - Street 1:70 HASTINGS ST STE LL2
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5439
Mailing Address - Country:US
Mailing Address - Phone:781-261-0085
Mailing Address - Fax:781-253-5240
Practice Address - Street 1:70 HASTINGS ST STE LL2
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5439
Practice Address - Country:US
Practice Address - Phone:781-261-0085
Practice Address - Fax:781-253-5240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIVASKIN DERMATOLOGY AND AESTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty