Provider Demographics
NPI:1275575094
Name:THE PRINCETON CENTER FOR DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:THE PRINCETON CENTER FOR DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-924-7690
Mailing Address - Street 1:800 BUNN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:609-924-1033
Mailing Address - Fax:609-924-7055
Practice Address - Street 1:800 BUNN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1968
Practice Address - Country:US
Practice Address - Phone:609-924-1033
Practice Address - Fax:609-924-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087125Medicare ID - Type Unspecified