Provider Demographics
NPI:1336104561
Name:PRINCETON DERMATOLOGY ASSOCIATESPC
Entity Type:Organization
Organization Name:PRINCETON DERMATOLOGY ASSOCIATESPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAUFMANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:609-683-4999
Mailing Address - Street 1:208 BUNN DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2851
Mailing Address - Country:US
Mailing Address - Phone:609-683-4999
Mailing Address - Fax:609-683-0298
Practice Address - Street 1:208 BUNN DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2851
Practice Address - Country:US
Practice Address - Phone:609-683-4999
Practice Address - Fax:609-683-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDA1887OtherRAILROAD MEDICARE
NJ2152529000OtherAMERIHEALTH
NJDA1887OtherRAILROAD MEDICARE
NJ068645Medicare ID - Type Unspecified