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General NPI Number Information
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NPI Number | 1649361643
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Entity Type | Organization
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Legal Business Name | 21ST CENTURY DERMATOLOGY,LLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 1 WEST RIDGEWOOD AVENUE SUITE 305
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City | PARAMUS
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State | NJ
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Zip | 07652-2359
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Country | US
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Telephone | 201-445-8786
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Fax | 201-445-8811
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Provider Business Mailing Address
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Address Line | 1 WEST RIDGEWOOD AVENUE SUITE 305
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City | PARAMUS
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State | NJ
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Zip | 07652-2361
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Country | US
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Telephone | 201-445-8786
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Fax | 201-445-8811
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. MARCY GOLDSTEIN
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Credential | MD
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Telephone | 201-445-8786
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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 |
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License Number State | NJ
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