Provider Demographics
NPI:1477031318
Name:WELLNESS DERMATOLOGY LLC
Entity Type:Organization
Organization Name:WELLNESS DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERINE
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:KUPETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-947-3786
Mailing Address - Street 1:638 LAWRENCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4208
Mailing Address - Country:US
Mailing Address - Phone:609-337-7643
Mailing Address - Fax:609-337-7648
Practice Address - Street 1:638 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4208
Practice Address - Country:US
Practice Address - Phone:609-337-7643
Practice Address - Fax:609-337-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty