Provider Demographics
NPI:1245603281
Name:DW DERM PC
Entity Type:Organization
Organization Name:DW DERM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-797-7770
Mailing Address - Street 1:23-00 ROUTE 208 SOUTH
Mailing Address - Street 2:SUITE 1-2
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1558
Mailing Address - Country:US
Mailing Address - Phone:201-797-7770
Mailing Address - Fax:201-797-1660
Practice Address - Street 1:23-00 ROUTE 208 SOUTH
Practice Address - Street 2:SUITE 1-2
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1558
Practice Address - Country:US
Practice Address - Phone:201-797-7770
Practice Address - Fax:201-797-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty