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General NPI Number Information
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NPI Number | 1992260640
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Entity Type | Organization
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Legal Business Name | SKIN ESSENTIALS DERMATOLOGY PC
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 13336 41ST RD STE 2M
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City | FLUSHING
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State | NY
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Zip | 11355-3666
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Country | US
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Telephone | 718-463-0093
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Fax | 718-463-0486
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Provider Business Mailing Address
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Address Line | 1053 LAKEVILLE RD
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3041
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Country | US
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Telephone | 718-926-5154
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Fax | 718-463-0486
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | DR. WINIFRED S CHU
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Credential | DO
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Telephone | 718-463-0093
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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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