Provider Demographics
NPI:1659889756
Name:DERMODY, JAMES (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DERMODY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080
Mailing Address - Country:US
Mailing Address - Phone:908-222-0533
Mailing Address - Fax:908-222-2729
Practice Address - Street 1:126 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080
Practice Address - Country:US
Practice Address - Phone:908-222-0533
Practice Address - Fax:908-222-2729
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MS00011800207SG0203X, 207SG0205X, 207SM0001X
NJ93066207SG0205X, 207SM0001X, 207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical Genetics
No207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic Pathology