Provider Demographics
NPI:1497841787
Name:DERMATOLOGIX, INC
Entity Type:Organization
Organization Name:DERMATOLOGIX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-927-5885
Mailing Address - Street 1:1401 NEW RD STE A
Mailing Address - Street 2:PO BOX 107
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1121
Mailing Address - Country:US
Mailing Address - Phone:609-927-5885
Mailing Address - Fax:609-927-5565
Practice Address - Street 1:1401 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1121
Practice Address - Country:US
Practice Address - Phone:609-927-5885
Practice Address - Fax:609-927-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07151700174400000X
NJ25MA07850300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052440SGYOtherMEDICARE PROVIDER NUMBER
NJ091049SGYOtherMEDICARE PROVIDER NUMBER
NJ=========OtherPRACTICE TIN
NJ052440SGYOtherMEDICARE PROVIDER NUMBER