Provider Demographics
NPI:1831977024
Name:CLEARSOLUTIONS DERMATOLOGY GROUP NEW JERSEY
Entity type:Organization
Organization Name:CLEARSOLUTIONS DERMATOLOGY GROUP NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:STABACK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, MS
Authorized Official - Phone:732-991-6579
Mailing Address - Street 1:6 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1074
Mailing Address - Country:US
Mailing Address - Phone:732-991-6579
Mailing Address - Fax:
Practice Address - Street 1:402 LACEY RD.
Practice Address - Street 2:UNIT C
Practice Address - City:MANCHESTER TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:877-425-7756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty