Provider Demographics
NPI:1881628907
Name:FAMILY DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:FAMILY DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CARBONARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-232-7500
Mailing Address - Street 1:900 ROUTE 168
Mailing Address - Street 2:SUITE F5
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3233
Mailing Address - Country:US
Mailing Address - Phone:856-232-7500
Mailing Address - Fax:856-232-7506
Practice Address - Street 1:900 ROUTE 168
Practice Address - Street 2:SUITE F5
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3233
Practice Address - Country:US
Practice Address - Phone:856-232-7500
Practice Address - Fax:856-232-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2619702Medicaid
NJ103305Medicare PIN
NJ2619702Medicaid