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General NPI Number Information
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NPI Number | 1063144715
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY INSTITUTE OF PRINCETON LLC
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 601 EWING ST STE C3
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City | PRINCETON
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State | NJ
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Zip | 08540-2756
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Country | US
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Telephone | 609-269-4957
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 588
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City | KINGSTON
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State | NJ
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Zip | 08528-0588
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ELLEN DABELA
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Credential | MD
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Telephone | 609-222-4702
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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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