Provider Demographics
NPI:1326496241
Name:NJ CERTIFIED DERMATOLOGY PC
Entity Type:Organization
Organization Name:NJ CERTIFIED DERMATOLOGY PC
Other - Org Name:DEDICATED DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-521-6143
Mailing Address - Street 1:1580 LAKEWOOD RD STE 16
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3287
Mailing Address - Country:US
Mailing Address - Phone:732-456-7777
Mailing Address - Fax:848-251-2189
Practice Address - Street 1:2895 HAMILTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6172
Practice Address - Country:US
Practice Address - Phone:732-456-7777
Practice Address - Fax:848-251-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103608008Medicaid
PA773906OtherMEDICARE PTAN
PA341562Medicare PIN
PA200425Medicare PIN