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General NPI Number Information
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NPI Number | 1760965453
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Entity Type | Organization
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Legal Business Name | ELITE SKIN CARE NYC
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 42 BROADWAY FL 12
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City | NEW YORK
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State | NY
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Zip | 10004-3892
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Country | US
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Telephone | 212-203-7415
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Fax |
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Provider Business Mailing Address
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Address Line | 211 E 43RD ST STE 716
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City | NEW YORK
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State | NY
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Zip | 10017-4707
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Country | US
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Telephone | 212-321-0109
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DMITRIY SCHWARZBURG
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Credential | MD
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Telephone | 212-920-7790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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