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General NPI Number Information
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NPI Number | 1487169702
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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 | 12/08/2017
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 670 BROADWAY
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City | BAYONNE
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State | NJ
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Zip | 07002-4726
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Country | US
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Telephone | 732-456-7777
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Fax | 848-251-2189
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Provider Business Mailing Address
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Address Line | 1580 LAKEWOOD RD STE 16
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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 | 848-251-2189
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Authorized Official
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Title or Position | MD/OWNER
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Name | RAMI E GEFFNER
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Credential |
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Telephone | 732-456-7777
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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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