1063144715 NPI number — DERMATOLOGY INSTITUTE OF PRINCETON LLC

Table of content: (NPI 1063144715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063144715 NPI number — DERMATOLOGY INSTITUTE OF PRINCETON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGY INSTITUTE OF PRINCETON LLC
Provider Last Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1063144715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 588
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08528-0588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 EWING ST STE C3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-2756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-269-4957
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DABELA
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
609-222-4702

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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