Provider Demographics
NPI:1679700868
Name:SON DERMATOLOGY, PC
Entity Type:Organization
Organization Name:SON DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:B
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-944-3800
Mailing Address - Street 1:200 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4363
Mailing Address - Country:US
Mailing Address - Phone:201-944-3800
Mailing Address - Fax:201-944-3804
Practice Address - Street 1:200 GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4363
Practice Address - Country:US
Practice Address - Phone:201-944-3800
Practice Address - Fax:201-944-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
127719Medicare UPIN