Provider Demographics
NPI:1720652514
Name:DERMATOLOGY OF POMPANO LLC
Entity type:Organization
Organization Name:DERMATOLOGY OF POMPANO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DELGADO
Authorized Official - Last Name:KOZIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-960-5404
Mailing Address - Street 1:2040 E SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7596
Mailing Address - Country:US
Mailing Address - Phone:954-960-5404
Mailing Address - Fax:754-800-7174
Practice Address - Street 1:2040 E SAMPLE RD
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7596
Practice Address - Country:US
Practice Address - Phone:954-960-5404
Practice Address - Fax:754-800-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty