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General NPI Number Information
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NPI Number | 1497413520
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Entity Type | Organization
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Legal Business Name | SKINNERGIE LLC
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 4330 W BROWARD BLVD STE O
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City | PLANTATION
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State | FL
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Zip | 33317-3754
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Country | US
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Telephone | 786-270-8375
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Fax |
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Provider Business Mailing Address
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Address Line | 18830 NW 44TH CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-2626
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Country | US
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Telephone | 786-270-8375
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANGELA S GETER GAINES
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Credential |
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Telephone | 786-270-8375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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