Provider Demographics
NPI:1295094589
Name:APPEARANCE DERMATOLOGY EHT LLC
Entity type:Organization
Organization Name:APPEARANCE DERMATOLOGY EHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIRGIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:TOOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-691-3442
Mailing Address - Street 1:6106 BLACK HORSE PIKE
Mailing Address - Street 2:UNIT B1
Mailing Address - City:EGG HAEBOR TWSP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234
Mailing Address - Country:US
Mailing Address - Phone:609-484-8700
Mailing Address - Fax:609-484-8711
Practice Address - Street 1:2466 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361
Practice Address - Country:US
Practice Address - Phone:856-691-3442
Practice Address - Fax:856-691-6582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5133203Medicaid
E54146Medicare UPIN
NJ62330RQYMedicare PIN