Provider Demographics
NPI:1457613309
Name:MORGAN DERMATOLOGY
Entity Type:Organization
Organization Name:MORGAN DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-508-9390
Mailing Address - Street 1:3405 STATE ROUTE 33 FL 2
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2766
Mailing Address - Country:US
Mailing Address - Phone:732-508-9390
Mailing Address - Fax:732-774-4028
Practice Address - Street 1:3405 STATE ROUTE 33 FL 2
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2766
Practice Address - Country:US
Practice Address - Phone:732-508-9390
Practice Address - Fax:732-774-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08863000261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty