Provider Demographics
NPI:1134264260
Name:HUNTERDON DERMATOLOGY, LLC
Entity type:Organization
Organization Name:HUNTERDON DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CASSETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-782-1647
Mailing Address - Street 1:8 MAIN ST
Mailing Address - Street 2:SUITE #20
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1468
Mailing Address - Country:US
Mailing Address - Phone:908-782-1647
Mailing Address - Fax:908-782-7296
Practice Address - Street 1:8 MAIN ST
Practice Address - Street 2:SUITE #20
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1468
Practice Address - Country:US
Practice Address - Phone:908-782-1647
Practice Address - Fax:908-782-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094505Medicare ID - Type Unspecified
NJI23359Medicare UPIN