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SKINFLUENCE MEDICAL PC
NPI 1770963084
Specialist in New York, NY

Active since June 02, 2015CLIA 33D2098458 · Waiver
1047 PARK AVE, NEW YORK, NY 10028(212) 754-6363(212) 289-4777 Get Directions Write a Review

NPPES record last updated: June 2, 2015. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Skinfluence Medical Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SKINFLUENCE MEDICAL PC (NPI 1770963084) is a healthcare organization registered as a specialist in New York, New York and active in the NPI registry since June 2015. The organization holds a CLIA Waiver certificate valid through July 7, 2027 and lists Marina I Peredo, Owner, as its authorized official.

NPPES Registry Identity

NPI1770963084
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSKINFLUENCE MEDICAL PC
Location Address1047 PARK AVENew York, NY 10028-1002
Mailing Address1047 Park AveNew York, NY 10028-1002 · (212) 754-6363 · Fax (212) 289-4777
Phone(212) 754-6363
Fax(212) 289-4777
Organization SubpartNo
Authorized OfficialMarina I PeredoOwner · (631) 863-3223
Enumeration DateJune 2, 2015
✔ NPI 1770963084 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NY · 190716
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1047 PARK AVE, New York, NY 10028
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Skinfluence Medical Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Skinfluence Medical PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Andrew Peredo, MD
Plastic and Reconstructive Surgery
NPI 1043509227
110 E MAIN ST STE 6
Huntington, NY 11743
(631) 424-3600
✔ PECOS✔ Accepts Medicare29 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2098458

Skinfluence Medical, PC · New York, NY
Active · expires Jul 7, 2027
CLIA Number33D2098458
Laboratory TypePhysician Office
Certificate Effective DateJuly 8, 2025
Certificate Expiration DateJuly 7, 2027
Laboratory DirectorDr. Marina I. Peredo
Laboratory Phone(212) 754-6363
Laboratory LocationSkinfluence Medical, PC1047 Park Avenue, New York, NY 10028
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Skinfluence Medical PC's NPI number?

The NPI number for Skinfluence Medical PC is 1770963084. It was assigned to this organization in the NPPES registry on June 2, 2015.

Where is Skinfluence Medical PC located?

Skinfluence Medical PC is located at 1047 Park Ave, New York, NY 10028. The listed phone number is (212) 754-6363.

What is Skinfluence Medical PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Skinfluence Medical PC enrolled in Medicare?

Yes. Skinfluence Medical PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Skinfluence Medical PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Plastic and Reconstructive Surgery) reassigns their Medicare billing to Skinfluence Medical PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Skinfluence Medical PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2098458) is associated with this NPI, valid through July 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Skinfluence Medical PC was last updated on June 2, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.