Provider Demographics
NPI:1073646212
Name:CENTER FOR DERMATOLOGY PA
Entity Type:Organization
Organization Name:CENTER FOR DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-736-9535
Mailing Address - Street 1:128 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2283
Mailing Address - Country:US
Mailing Address - Phone:973-736-9535
Mailing Address - Fax:973-736-2607
Practice Address - Street 1:128 COLUMBIA TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2283
Practice Address - Country:US
Practice Address - Phone:973-736-9535
Practice Address - Fax:973-736-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06197500207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527145Medicare ID - Type Unspecified