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General NPI Number Information
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NPI Number | 1558314542
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF THE NORTHEAST, PC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 745A ROUTE 63
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City | CHESTERFIELD
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State | NH
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Zip | 03443-3604
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Country | US
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Telephone | 800-303-8984
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Fax | 603-363-4450
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Provider Business Mailing Address
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Address Line | PO BOX 910
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City | GREENFIELD
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State | MA
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Zip | 01302-0910
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Country | US
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Telephone | 413-772-8500
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Fax | 413-772-8900
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE LUIS CRESPO
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Credential | MD
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Telephone | 800-303-8984
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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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