Healthcare Provider Details

I. General information

NPI: 1962428474
Provider Name (Legal Business Name): THE DERMATOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 MOUNT PLEASANT AVE SUITE 103
WEST ORANGE NJ
07052-2744
US

IV. Provider business mailing address

347 MOUNT PLEASANT AVE SUITE 205
WEST ORANGE NJ
07052-2744
US

V. Phone/Fax

Practice location:
  • Phone: 973-571-2121
  • Fax: 973-239-1591
Mailing address:
  • Phone: 973-571-2121
  • Fax: 973-239-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL S GROISSER
Title or Position: PHYSICIAN ADMINISTRATOR
Credential: MD
Phone: 973-571-2121