Healthcare Provider Details

I. General information

NPI: 1164416301
Provider Name (Legal Business Name): ADVANCED DERMATOLOGY LASER AND MOHS SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E GROVE ST
WESTFIELD NJ
07090-1687
US

IV. Provider business mailing address

240 E GROVE ST
WESTFIELD NJ
07090-1687
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-6446
  • Fax: 908-232-6447
Mailing address:
  • Phone: 908-232-6446
  • Fax: 908-232-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JEROLD BRUCE GRAFF
Title or Position: PRESIDENT
Credential: MD
Phone: 908-232-6446