Healthcare Provider Details

I. General information

NPI: 1013623065
Provider Name (Legal Business Name): SDG DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 ONE MILE RD EXT
EAST WINDSOR NJ
08520-2505
US

IV. Provider business mailing address

33 E 33RD ST FL 12
NEW YORK NY
10016-5362
US

V. Phone/Fax

Practice location:
  • Phone: 609-443-4500
  • Fax:
Mailing address:
  • Phone: 212-283-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANELLE GORFINKLE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 925-819-6228