Provider Demographics
NPI:1033953229
Name:SKIN IMAGING INVESTOR GROUP
Entity type:Organization
Organization Name:SKIN IMAGING INVESTOR GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NISSINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-537-9979
Mailing Address - Street 1:30 COLUMBIA TPKE STE 201
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2253
Mailing Address - Country:US
Mailing Address - Phone:877-665-3723
Mailing Address - Fax:973-218-9633
Practice Address - Street 1:30 COLUMBIA TPKE STE 201
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2253
Practice Address - Country:US
Practice Address - Phone:877-665-3723
Practice Address - Fax:973-218-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center