Provider Demographics
NPI:1538270335
Name:AQUA DERMATOLOGY OF FLORIDA, PA
Entity type:Organization
Organization Name:AQUA DERMATOLOGY OF FLORIDA, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-313-2515
Mailing Address - Street 1:PO BOX 748497
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8497
Mailing Address - Country:US
Mailing Address - Phone:239-313-2515
Mailing Address - Fax:
Practice Address - Street 1:900 VILLAGE SQUARE XING STE 210
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4550
Practice Address - Country:US
Practice Address - Phone:239-313-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2127Medicare PIN
FLK2127CMedicare PIN
FLK2127AMedicare PIN
FLK2127BMedicare PIN