Provider Demographics
NPI:1811129141
Name:DERMATOLOGY AND SKIN SURGERY CENTER, PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:DERMATOLOGY AND SKIN SURGERY CENTER, PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:KIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-301-9500
Mailing Address - Street 1:220 RIDGEDALE AVE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1348
Mailing Address - Country:US
Mailing Address - Phone:973-301-9500
Mailing Address - Fax:973-301-0435
Practice Address - Street 1:220 RIDGEDALE AVE
Practice Address - Street 2:SUITE A3
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1348
Practice Address - Country:US
Practice Address - Phone:973-301-9500
Practice Address - Fax:973-301-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89501207N00000X
NY233992-1207N00000X
NJ25MA0837050207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty