Healthcare Provider Details

I. General information

NPI: 1336399112
Provider Name (Legal Business Name): DENISE MASTROMONACO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 NEWMAN SPRINGS RD STE 200
RED BANK NJ
07701-5691
US

IV. Provider business mailing address

200 SCHULZ DR STE 2
RED BANK NJ
07701-6745
US

V. Phone/Fax

Practice location:
  • Phone: 732-426-3420
  • Fax:
Mailing address:
  • Phone: 732-741-0970
  • Fax: 848-800-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MB06489100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MB06489100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number05010384
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: