Provider Demographics
NPI:1710074778
Name:ADVANCED DERMATOLOGY CENTER, P.C.
Entity Type:Organization
Organization Name:ADVANCED DERMATOLOGY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-635-1200
Mailing Address - Street 1:18 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2275
Mailing Address - Country:US
Mailing Address - Phone:732-635-1200
Mailing Address - Fax:732-635-1266
Practice Address - Street 1:18 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2275
Practice Address - Country:US
Practice Address - Phone:732-635-1200
Practice Address - Fax:732-635-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066541Medicare ID - Type Unspecified