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General NPI Number Information
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NPI Number | 1538626049
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Entity Type | Organization
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Legal Business Name | NOVA DERMATOLOGY LLC
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 455 ROUTE 70 W
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City | CHERRY HILL
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State | NJ
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Zip | 08002-3524
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Country | US
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Telephone | 415-802-1310
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | MOORESTOWN
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State | NJ
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Zip | 08057-0204
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Country | US
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Telephone | 415-802-1310
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SANDRA KOPP
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Credential | MD
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Telephone | 415-802-1310
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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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