Provider Demographics
NPI:1790744142
Name:DERMATOLOGY ASSOCIATES OF GLEN ROCK, P.A.
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF GLEN ROCK, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-652-6060
Mailing Address - Street 1:348 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1542
Mailing Address - Country:US
Mailing Address - Phone:201-652-6060
Mailing Address - Fax:201-652-1882
Practice Address - Street 1:348 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1542
Practice Address - Country:US
Practice Address - Phone:201-652-6060
Practice Address - Fax:201-652-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0093661Medicaid
NJDC9002Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NJ0093661Medicaid