Provider Demographics
NPI:1689015877
Name:THE DERMATOLOGY CLINIC
Entity Type:Organization
Organization Name:THE DERMATOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SWARNA
Authorized Official - Middle Name:PRIYA
Authorized Official - Last Name:SIVANESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-274-5513
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-0330
Mailing Address - Country:US
Mailing Address - Phone:650-274-5513
Mailing Address - Fax:
Practice Address - Street 1:2315 ROUTE 34
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1444
Practice Address - Country:US
Practice Address - Phone:650-274-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty