Provider Demographics
NPI:1558901025
Name:BUCKS COUNTY DERMAESTHETICS LLC
Entity Type:Organization
Organization Name:BUCKS COUNTY DERMAESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-802-1310
Mailing Address - Street 1:1717 NEWTOWN LANGHORNE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1091
Mailing Address - Country:US
Mailing Address - Phone:415-802-1310
Mailing Address - Fax:
Practice Address - Street 1:1717 NEWTOWN LANGHORNE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1091
Practice Address - Country:US
Practice Address - Phone:415-802-1310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty