1194091884 NPI number — ACCREDITED DERMATOLOGY DELAWARE

Table of content: (NPI 1194091884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194091884 NPI number — ACCREDITED DERMATOLOGY DELAWARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCREDITED DERMATOLOGY DELAWARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194091884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1580 LAKEWOOD RD
Provider Second Line Business Mailing Address:
UNIT 16B
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08755-3287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-731-6118
Provider Business Mailing Address Fax Number:
732-244-8482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1580 LAKEWOOD RD
Provider Second Line Business Practice Location Address:
UNIT 16B
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755-3287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-731-6118
Provider Business Practice Location Address Fax Number:
732-244-8482
Provider Enumeration Date:
03/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GEFFNER
Authorized Official First Name:
RAMI
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
732-731-6118

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  C1-0009601 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com