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General NPI Number Information
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NPI Number | 1053771048
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Entity Type | Organization
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Legal Business Name | DERMONE DERMATOLOGY ASSOCIATES OF THE GARDEN STATE, PC
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 501 IRON BRIDGE ROAD
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 800-337-6663
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Fax | 732-731-6135
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Provider Business Mailing Address
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Address Line | FOUR TOWER BRIDGE, 200 BARR HARBOR DR SUITE 200
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City | WEST CONSHOHOCKEN
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State | PA
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Zip | 19428-1518
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Country | US
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Telephone | 848-240-2812
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Fax | 732-731-6135
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Authorized Official
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Title or Position | CHIEF FINANCIAL & ADMIN. OFFICER
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Name | JEFFREY J PETRICK
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Credential |
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Telephone | 484-240-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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