Provider Demographics
NPI:1700973617
Name:APPEARANCE DERMATOLOGY LLC
Entity Type:Organization
Organization Name:APPEARANCE DERMATOLOGY LLC
Other - Org Name:ADVANCED DERMATOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
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 1:2466 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361
Mailing Address - Country:US
Mailing Address - Phone:856-691-3442
Mailing Address - Fax:856-691-6582
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:2006-10-10
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05327500207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5133203Medicaid
NJ623330Medicare ID - Type Unspecified
NJ5133203Medicaid