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General NPI Number Information
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NPI Number | 1033069307
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Entity Type | Organization
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Legal Business Name | NJ CERTIFIED DERMATOLOGY PC
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Dates
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Enumeration Date | 01/28/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 2275 ROUTE 33 STE 303
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City | HAMILTON
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State | NJ
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Zip | 08690-1748
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Country | US
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Telephone | 732-456-7777
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Fax | 848-251-2191
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Provider Business Mailing Address
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Address Line | 1580 LAKEWOOD RD STE 17
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City | TOMS RIVER
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State | NJ
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Zip | 08755-3287
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Country | US
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Telephone | 732-456-7777
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Fax | 848-251-2191
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | LAWRENCE LAZELLE ANDERSON
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Credential |
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Telephone | 903-521-6143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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