Provider Demographics
NPI:1942201645
Name:DERMATOLOGY CONSULTANTS OF NORTHERN JERSEY LLC
Entity Type:Organization
Organization Name:DERMATOLOGY CONSULTANTS OF NORTHERN JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:POPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-993-1433
Mailing Address - Street 1:261 JAMES ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6392
Mailing Address - Country:US
Mailing Address - Phone:973-993-1433
Mailing Address - Fax:973-993-1176
Practice Address - Street 1:261 JAMES ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6392
Practice Address - Country:US
Practice Address - Phone:973-993-1433
Practice Address - Fax:973-993-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ57078207N00000X
NJ57081207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID