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General NPI Number Information
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NPI Number | 1689015877
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Entity Type | Organization
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Legal Business Name | THE DERMATOLOGY CLINIC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 2315 ROUTE 34
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City | MANASQUAN
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State | NJ
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Zip | 08736-1444
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Country | US
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Telephone | 650-274-5513
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 330
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City | HAZLET
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State | NJ
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Zip | 07730-0330
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Country | US
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Telephone | 650-274-5513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SWARNA PRIYA SIVANESAN
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Credential | M.D
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Telephone | 650-274-5513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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