Provider Demographics
NPI:1083846091
Name:MEDICAL & COSMETIC DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MEDICAL & COSMETIC DERMATOLOGY ASSOCIATES
Other - Org Name:LAKES SKIN CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-644-0228
Mailing Address - Street 1:841 FRANKLIN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1418
Mailing Address - Country:US
Mailing Address - Phone:201-644-0228
Mailing Address - Fax:201-644-0229
Practice Address - Street 1:841 FRANKLIN AVE STE 4
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1418
Practice Address - Country:US
Practice Address - Phone:201-644-0228
Practice Address - Fax:201-644-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08353300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty