Provider Demographics
NPI:1992908578
Name:REFLECTIONS DERMATOLOGY AND CENTER FOR SKIN CARE PLLC
Entity type:Organization
Organization Name:REFLECTIONS DERMATOLOGY AND CENTER FOR SKIN CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PALCESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-895-8818
Mailing Address - Street 1:440 W MORSE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4206
Mailing Address - Country:US
Mailing Address - Phone:407-895-8818
Mailing Address - Fax:407-291-3800
Practice Address - Street 1:875 OUTER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814
Practice Address - Country:US
Practice Address - Phone:407-895-8818
Practice Address - Fax:407-291-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9674207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF534Medicare PIN