Mend My Skin LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

MEND MY SKIN LLC

Practice address

23 Centennial Dr
Peabody, MA 01960-7901

Phone

(978) 525-0100

NPI assigned

Jan 13, 2021

Organization subpart

No

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

Authorized official

Name

Gary Mendese, MD

Title

Member

Phone

(978) 235-1063

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1801485982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CANDLEWOOD RD",
            "city": "LYNNFIELD",
            "state": "MA",
            "postal_code": "019402437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 CENTENNIAL DR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019607901",
            "telephone_number": "978-525-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEND MY SKIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "MENDESE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "978-235-1063",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.