Provider Demographics
NPI:1457796567
Name:DERMATOLOGY INSTITUTE AND LASER CENTER
Entity type:Organization
Organization Name:DERMATOLOGY INSTITUTE AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ROS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-472-1000
Mailing Address - Street 1:1100 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-472-1000
Mailing Address - Fax:
Practice Address - Street 1:1100 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-472-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08665600207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty