Skinfluence Medical PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

190716 Issued in NY

Legal business name

SKINFLUENCE MEDICAL PC

Practice address

1047 Park Ave
New York, NY 10028-1002

Phone

(212) 754-6363

Fax

(212) 289-4777

NPI assigned

Jun 2, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marina I Peredo, M.D.

Title

Owner

Phone

(631) 863-3223

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew L Peredo, MD

  • Plastic Surgery Physician
  • Huntington, NY
  • NPI 1043509227
  Medicare reassignment NPD
• Sherry Thomas, MD MPH

  • Obstetrics & Gynecology Physician
  • Westlake Village, CA
  • NPI 1932154580
  NPD
• Ruthann Parise, DPM

  • Podiatrist
  • Malverne, NY
  • NPI 1003992041
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1770963084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1047 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100281002",
            "telephone_number": "212-754-6363",
            "fax_number": "212-289-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1047 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100281002",
            "telephone_number": "212-754-6363",
            "fax_number": "212-289-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKINFLUENCE MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-02",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "PEREDO",
        "authorized_official_first_name": "MARINA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-863-3223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "190716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marie M Skidmore
• Wendy Skillern, LCSW
• Skin & Aesthetic Surgery of Manhattan
• Skin District
• Skin Specialty Dermatology - Fran E. Cook-Bolden M.D., P.C.
• Skinly LLC
• Aaron Skinner, LCSW
• Carly Skinner, FNP-BC
• Correl Skinner
• David J Skinner, M.D.

• Specialist in New York, NY
• Providers in New York, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.