Provider Demographics
NPI:1124185004
Name:DERMATOLOGY PHYSICIANS OF SOUTH JERSEY, PA
Entity Type:Organization
Organization Name:DERMATOLOGY PHYSICIANS OF SOUTH JERSEY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-546-8672
Mailing Address - Street 1:112 WHITE HORSE PIKE
Mailing Address - Street 2:RT. 30
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1908
Mailing Address - Country:US
Mailing Address - Phone:856-546-8672
Mailing Address - Fax:856-546-5315
Practice Address - Street 1:150 CENTURY PKWY STE 105
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1129
Practice Address - Country:US
Practice Address - Phone:856-206-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DERMATOLOGY ASSOCIATES OF SOUTH JERSEY, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH34146Medicare UPIN
NJH12521Medicare UPIN
NJC34208Medicare UPIN
NJE13134Medicare UPIN