Basic Information
| Provider Information | |||||||||
| NPI: | 1003003195 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AVENTURA DERMATOLOGY & COSMETIC CENTER, P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FT. LAUDERDALE DERMATOLOGY AND COSMETIC CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5721 NE 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333082703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547720416 | ||||||||
| FaxNumber: | 9547725716 | ||||||||
| Practice Location | |||||||||
| Address1: | 5721 NE 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333082703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547720416 | ||||||||
| FaxNumber: | 9547725716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | CHAPLIK | ||||||||
| AuthorizedOfficialFirstName: | IGOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9547720416 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NS0135X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
No ID Information.