Provider Demographics
NPI:1932259637
Name:SKIN CARE SPECIALISTS
Entity type:Organization
Organization Name:SKIN CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:GERSON
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-382-8244
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-382-8244
Mailing Address - Fax:216-382-7464
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 410
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-382-8244
Practice Address - Fax:216-382-7464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEONARD G. KATZ MD INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-12
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35022055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2103128Medicaid
OH2103128Medicaid