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General NPI Number Information
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NPI Number | 1407374481
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Entity Type | Organization
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Legal Business Name | CENTER FOR SKIN SURGERY & DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2928 MAIN ST STE 100
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City | GLASTONBURY
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State | CT
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Zip | 06033-1007
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Country | US
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Telephone | 860-633-2332
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Fax | 860-633-2352
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Provider Business Mailing Address
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Address Line | 2928 MAIN ST STE 100
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City | GLASTONBURY
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State | CT
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Zip | 06033-1007
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Country | US
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Telephone | 860-633-2332
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Fax | 860-633-2352
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | CHRISTINE GIGLIO
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Credential |
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Telephone | 860-676-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 040694
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 040694
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License Number State | CT
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