1871893529 NPI number — ACCURATE DERMATOLOGY PA, LLC

Table of content: (NPI 1871893529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871893529 NPI number — ACCURATE DERMATOLOGY PA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURATE DERMATOLOGY PA, LLC
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:
1871893529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08754-2104
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:
2805 FRINGE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18040
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:
10/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOSCATO
Authorized Official First Name:
RACHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
732-731-6118

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ND0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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