Provider Demographics
NPI:1033518758
Name:THE DERMATOLOGY CENTER OF NJ,PC
Entity Type:Organization
Organization Name:THE DERMATOLOGY CENTER OF NJ,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-393-9755
Mailing Address - Street 1:745 US HIGHWAY 202/206
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1758
Mailing Address - Country:US
Mailing Address - Phone:908-393-9755
Mailing Address - Fax:908-393-9757
Practice Address - Street 1:745 US HIGHWAY 202/206
Practice Address - Street 2:SUITE 102
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1758
Practice Address - Country:US
Practice Address - Phone:908-393-9755
Practice Address - Fax:908-393-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07870700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1598991960OtherNPI