Provider Demographics
NPI:1598991960
Name:THE DERMATOLOGY CENTER OF NEW JERSEY, PC
Entity Type:Organization
Organization Name:THE DERMATOLOGY CENTER OF NEW JERSEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-448-9378
Mailing Address - Street 1:1376 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1410
Mailing Address - Country:US
Mailing Address - Phone:908-393-9755
Mailing Address - Fax:908-393-9757
Practice Address - Street 1:745 US HIGHWAY 202/206
Practice Address - Street 2:SUITE 102
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1758
Practice Address - Country:US
Practice Address - Phone:908-393-9755
Practice Address - Fax:908-393-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07870700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty