Provider Demographics
NPI:1497921738
Name:RANDOLPH DERMATOLOGY AND MOHS MICROGRAPHIC SURGERY LLC
Entity Type:Organization
Organization Name:RANDOLPH DERMATOLOGY AND MOHS MICROGRAPHIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-309-2016
Mailing Address - Street 1:390 ROUTE 10 W
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2141
Mailing Address - Country:US
Mailing Address - Phone:973-366-6303
Mailing Address - Fax:973-891-1505
Practice Address - Street 1:390 ROUTE 10 W
Practice Address - Street 2:SUITE 102
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2141
Practice Address - Country:US
Practice Address - Phone:973-366-6303
Practice Address - Fax:973-891-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07842207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty