Healthcare Provider Details

I. General information

NPI: 1285857110
Provider Name (Legal Business Name): HAMETZ & PICASCIA DERMATOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SCHANCK RD # 55 SUITE B-3
FREEHOLD NJ
07728-2964
US

IV. Provider business mailing address

77 SCHANCK RD # 55 SUITE B-3
FREEHOLD NJ
07728-2964
US

V. Phone/Fax

Practice location:
  • Phone: 732-462-9800
  • Fax: 732-308-1647
Mailing address:
  • Phone: 732-462-9800
  • Fax: 732-308-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA34616
License Number StateNJ

VIII. Authorized Official

Name: DR. IRWIN HAMETZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-462-9800