Provider Demographics
NPI:1992260640
Name:SKIN ESSENTIALS DERMATOLOGY PC
Entity type:Organization
Organization Name:SKIN ESSENTIALS DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-463-0093
Mailing Address - Street 1:1053 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3041
Mailing Address - Country:US
Mailing Address - Phone:718-926-5154
Mailing Address - Fax:718-463-0486
Practice Address - Street 1:13336 41ST RD STE 2M
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3666
Practice Address - Country:US
Practice Address - Phone:718-463-0093
Practice Address - Fax:718-463-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty