Healthcare Provider Details

I. General information

NPI: 1528640786
Provider Name (Legal Business Name): CONTEMPORARY DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 FALMOUTH RD
MARSTONS MILLS MA
02648-1855
US

IV. Provider business mailing address

159 UPPER MOUNTAIN AVE
MONTCLAIR NJ
07042-1905
US

V. Phone/Fax

Practice location:
  • Phone: 201-704-5557
  • Fax:
Mailing address:
  • Phone: 201-704-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT NOSSA
Title or Position: OWNER
Credential: MD
Phone: 201-704-5557