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General NPI Number Information
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NPI Number | 1497841787
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Entity Type | Organization
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Legal Business Name | DERMATOLOGIX, INC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1401 NEW RD
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City | LINWOOD
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State | NJ
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Zip | 08221-1121
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Country | US
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Telephone | 609-927-5885
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Fax | 609-927-5565
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Provider Business Mailing Address
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Address Line | 1401 NEW RD STE A PO BOX 107
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City | LINWOOD
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State | NJ
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Zip | 08221-1121
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Country | US
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Telephone | 609-927-5885
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Fax | 609-927-5565
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JOSEPH J HONG
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Credential | M.D.
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Telephone | 609-927-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA07850300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA07151700
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License Number State | NJ
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