1801595343 NPI number — THE DERM GROUP LLP

Table of content: DR. MICHAEL WILLIAM TORELLI M.D. (NPI 1821008624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801595343 NPI number — THE DERM GROUP LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DERM GROUP LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801595343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11924 FOREST HILL BLVD STE 10A-411
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-6256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-425-2929
Provider Business Mailing Address Fax Number:
561-810-1677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 SW 37TH AVE STE 804
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33133-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-306-9470
Provider Business Practice Location Address Fax Number:
305-440-1370
Provider Enumeration Date:
02/23/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GIUFFRIDA
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-461-2000

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105703407 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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