Provider Demographics
NPI:1679804330
Name:KINNELON DERMATOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:KINNELON DERMATOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JO-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SZYLIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-838-1771
Mailing Address - Street 1:135 KINNELON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2333
Mailing Address - Country:US
Mailing Address - Phone:973-838-1771
Mailing Address - Fax:973-492-2858
Practice Address - Street 1:135 KINNELON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2333
Practice Address - Country:US
Practice Address - Phone:973-838-1771
Practice Address - Fax:973-492-2858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04598300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ177698Medicare PIN