Healthcare Provider Details

I. General information

NPI: 1760537914
Provider Name (Legal Business Name): AFFILIATED DERMATOLOGISTS AND DERMATOLOGIC SURGEONS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SOUTH ST SUITE 1
MORRISTOWN NJ
07960-5377
US

IV. Provider business mailing address

182 SOUTH ST SUITE 1
MORRISTOWN NJ
07960-5377
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-0300
  • Fax: 973-539-5401
Mailing address:
  • Phone: 973-267-0300
  • Fax: 973-539-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: EMIL P BISACCIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-267-0300