Provider Demographics
NPI:1710031919
Name:LIGRESTI DERMATOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:LIGRESTI DERMATOLOGY ASSOCIATES PA
Other - Org Name:DOMINICK J LIGRESTI MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER LIGRESTI DERMATOLOGY ASSOCIAT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LIGRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-759-6569
Mailing Address - Street 1:36 NEWARK AVENUE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4120
Mailing Address - Country:US
Mailing Address - Phone:973-759-6569
Mailing Address - Fax:973-759-2562
Practice Address - Street 1:36 NEWARK AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4120
Practice Address - Country:US
Practice Address - Phone:973-759-6569
Practice Address - Fax:973-759-2562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40615207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F24025Medicare UPIN
C52879Medicare UPIN