Provider Demographics
NPI:1326141110
Name:DERMATOLOGY CENTER OF NORTH JERSEY
Entity Type:Organization
Organization Name:DERMATOLOGY CENTER OF NORTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-343-4745
Mailing Address - Street 1:1033 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:631-343-4745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05185900174400000X
NJ25MA06659700174400000X
NJ25MA07070600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1225094725OtherNPI #, DR. STERN
NJ8548781-006OtherCIGNA ID #, DR. QUAN
NJ6969678-002OtherCIGNA ID #, DR. STERN
NJ2298315OtherAETNA GROUP #
NJ1841219797OtherNPI #, DR. GOLD
NJ0722176-008OtherCIGNA ID #, DR. GOLD
NJ1578535910OtherNPI #, DR. QUAN
NJ580647Medicare ID - Type UnspecifiedPROVIDER ID #, DR. GOLD
NJ8548781-006OtherCIGNA ID #, DR. QUAN
NJ037949Medicare ID - Type UnspecifiedPROVIDER ID #, DR. QUAN
NJ2298315OtherAETNA GROUP #
NJ6969678-002OtherCIGNA ID #, DR. STERN
NJ0722176-008OtherCIGNA ID #, DR. GOLD