=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114789963
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL VEIN AND SKIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2024
-----------------------------------------------------
Last Update Date | 01/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5353 N FEDERAL HWY STE 303
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-3236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-860-7500
-----------------------------------------------------
Fax | 954-860-7550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10383 HAGEN RANCH RD STE 100
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-3782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-739-5252
-----------------------------------------------------
Fax | 561-739-5255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSHUA MATTHEW BERLIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-739-5252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------