Provider Demographics
NPI:1861838484
Name:DERMATOLOGY GROUP OF CENTRAL NEW JERSEY PA
Entity Type:Organization
Organization Name:DERMATOLOGY GROUP OF CENTRAL NEW JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-526-0526
Mailing Address - Street 1:3 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3001
Mailing Address - Country:US
Mailing Address - Phone:908-526-0526
Mailing Address - Fax:908-595-0123
Practice Address - Street 1:3 MONROE STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3001
Practice Address - Country:US
Practice Address - Phone:908-526-0526
Practice Address - Fax:908-595-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2648601Medicaid
NJ2648601Medicaid