Provider Demographics
NPI:1326098559
Name:RAMI E GEFFNER MD PA
Entity Type:Organization
Organization Name:RAMI E GEFFNER MD PA
Other - Org Name:ACCREDITED DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:E
Authorized Official - Last Name:GEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-244-4703
Mailing Address - Street 1:PO BOX 4979
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-4979
Mailing Address - Country:US
Mailing Address - Phone:732-244-4703
Mailing Address - Fax:732-244-2804
Practice Address - Street 1:111 W WATER ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6407
Practice Address - Country:US
Practice Address - Phone:732-244-4700
Practice Address - Fax:732-244-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03772900207N00000X
NJ25MA06782900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ07941000000OtherAMERIHEALTH
NJ2506744OtherAETNA HMO
NJ6943705Medicaid
NJ7633216OtherAETNA PPO
NJCA9639OtherRAILROAD MEDICARE
NJ07941000000OtherAMERIHEALTH
NJ694400Medicare PIN