Provider Demographics
NPI:1912374265
Name:QUALITY DERMATOLOGY
Entity Type:Organization
Organization Name:QUALITY DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAKS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:917-593-1722
Mailing Address - Street 1:180 TAYLORS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3306
Mailing Address - Country:US
Mailing Address - Phone:917-593-1722
Mailing Address - Fax:
Practice Address - Street 1:180 TAYLORS MILLS RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3306
Practice Address - Country:US
Practice Address - Phone:917-593-1722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00300300261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service