Provider Demographics
NPI:1174101828
Name:DERMATOLOGY INSTITUTE & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:DERMATOLOGY INSTITUTE & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CZERNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-258-4594
Mailing Address - Street 1:396 DANBURY RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2024
Mailing Address - Country:US
Mailing Address - Phone:203-442-1800
Mailing Address - Fax:
Practice Address - Street 1:396 DANBURY RD UNIT 6
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2024
Practice Address - Country:US
Practice Address - Phone:203-966-6305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty