Provider Demographics
NPI:1730104381
Name:MOORESTOWN DERMATOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:MOORESTOWN DERMATOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMISHION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-235-6565
Mailing Address - Street 1:110 MARTER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3124
Mailing Address - Country:US
Mailing Address - Phone:856-235-6565
Mailing Address - Fax:856-235-6566
Practice Address - Street 1:110 MARTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3124
Practice Address - Country:US
Practice Address - Phone:856-235-6565
Practice Address - Fax:856-235-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty