Provider Demographics
NPI:1184651440
Name:LIVINGSTON DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:LIVINGSTON DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-994-1170
Mailing Address - Street 1:201 S LIVINGSTON AVE
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4043
Mailing Address - Country:US
Mailing Address - Phone:973-994-1170
Mailing Address - Fax:
Practice Address - Street 1:201 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4043
Practice Address - Country:US
Practice Address - Phone:973-994-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ526682Medicare ID - Type Unspecified