=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134264260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUNTERDON DERMATOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 MAIN ST SUITE #20
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822-1468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-782-1647
-----------------------------------------------------
Fax | 908-782-7296
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 MAIN ST SUITE #20
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822-1468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-782-1647
-----------------------------------------------------
Fax | 908-782-7296
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. CHRISTOPHER TODD CASSETTY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 908-782-1647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------