Provider Demographics
NPI:1932166774
Name:DERMATOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHANN
Authorized Official - Last Name:KOBLENZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-235-1178
Mailing Address - Street 1:303 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2525
Mailing Address - Country:US
Mailing Address - Phone:856-235-1178
Mailing Address - Fax:856-722-9244
Practice Address - Street 1:303 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2525
Practice Address - Country:US
Practice Address - Phone:856-235-1178
Practice Address - Fax:856-722-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA20461207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJKO476332Medicare ID - Type Unspecified
NJB32937Medicare UPIN