Healthcare Provider Details

I. General information

NPI: 1508953035
Provider Name (Legal Business Name): DERMATOLOGY CENTER OF WASHINGTON TOWNSHIP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGS WAY E STE A3 WASHINGTON PAVILIONS
SEWELL NJ
08080-2237
US

IV. Provider business mailing address

100 KINGS WAY E STE A3 WASHINGTON PAVILIONS
SEWELL NJ
08080-2237
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-3331
  • Fax: 856-589-3416
Mailing address:
  • Phone: 856-589-3331
  • Fax: 856-589-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN M WINTER
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 856-589-3331