Provider Demographics
NPI:1942401070
Name:CENTER FOR DERMATOLOGIC CARE, LLC
Entity Type:Organization
Organization Name:CENTER FOR DERMATOLOGIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:P
Authorized Official - Last Name:RESNIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-542-6300
Mailing Address - Street 1:170 AVENUE AT THE COMMON
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4803
Mailing Address - Country:US
Mailing Address - Phone:732-542-6300
Mailing Address - Fax:732-542-6392
Practice Address - Street 1:170 AVENUE AT THE COMMON
Practice Address - Street 2:SUITE 2
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4803
Practice Address - Country:US
Practice Address - Phone:732-542-6300
Practice Address - Fax:732-542-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA050827207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty