Provider Demographics
NPI:1619702255
Name:SKINGRAFT NJ LLC
Entity type:Organization
Organization Name:SKINGRAFT NJ LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-685-5497
Mailing Address - Street 1:37 HAMPTON HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08535-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 HAMPTON HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MILLSTONE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08535-1004
Practice Address - Country:US
Practice Address - Phone:917-685-5497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty