Provider Demographics
NPI:1073729018
Name:ALTA DERMATOLOGY & SKIN CARE CENTER, LLC
Entity Type:Organization
Organization Name:ALTA DERMATOLOGY & SKIN CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:FINKELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-344-2849
Mailing Address - Street 1:701 COOPER RD
Mailing Address - Street 2:SUITE #13
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3800
Mailing Address - Country:US
Mailing Address - Phone:856-344-2849
Mailing Address - Fax:856-344-2938
Practice Address - Street 1:701 COOPER RD
Practice Address - Street 2:SUITE #13
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3800
Practice Address - Country:US
Practice Address - Phone:856-344-2849
Practice Address - Fax:856-344-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068924261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
H17046Medicare UPIN
038319Medicare ID - Type Unspecified