Provider Demographics
NPI:1508953035
Name:DERMATOLOGY CENTER OF WASHINGTON TOWNSHIP PC
Entity Type:Organization
Organization Name:DERMATOLOGY CENTER OF WASHINGTON TOWNSHIP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-589-3331
Mailing Address - Street 1:100 KINGS WAY E STE A3
Mailing Address - Street 2:WASHINGTON PAVILIONS
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2237
Mailing Address - Country:US
Mailing Address - Phone:856-589-3331
Mailing Address - Fax:856-589-3416
Practice Address - Street 1:100 KINGS WAY E STE A3
Practice Address - Street 2:WASHINGTON PAVILIONS
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2237
Practice Address - Country:US
Practice Address - Phone:856-589-3331
Practice Address - Fax:856-589-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2423791OtherAETNA
NJCJ2498OtherRR MEDICARE
0112030000OtherIBC
=========OtherBCBS OUT OF STATE
=========OtherHORIZON BCBS OF NJ
0112030000OtherIBC