Provider Demographics
NPI:1750449104
Name:AESTHETIC DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:AESTHETIC DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-596-3393
Mailing Address - Street 1:771 E ROUTE 70
Mailing Address - Street 2:SUITE D150
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2352
Mailing Address - Country:US
Mailing Address - Phone:856-596-3393
Mailing Address - Fax:856-596-3394
Practice Address - Street 1:771 E ROUTE 70
Practice Address - Street 2:SUITE D150
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2352
Practice Address - Country:US
Practice Address - Phone:856-596-3393
Practice Address - Fax:856-596-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53938207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty