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General NPI Number Information
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NPI Number | 1508580200
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Entity Type | Organization
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Legal Business Name | PINE ISLAND DERMATOLOGY, LLC
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 3365 BURNS RD STE 217
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4312
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Country | US
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Telephone | 772-485-5574
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Fax |
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Provider Business Mailing Address
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Address Line | 9118A SW 20TH CT
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City | DAVIE
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State | FL
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Zip | 33324-5074
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Country | US
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Telephone | 177-248-5557
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Fax |
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Authorized Official
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Title or Position | DERMATOLOGIST/PRESIDENT
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Name | DR. SERGEY ARUTYUNYAN
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Credential | DO
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Telephone | 772-485-5574
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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 |
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License Number State |
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