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General NPI Number Information
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NPI Number | 1700921269
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Entity Type | Organization
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Legal Business Name | BELLEVILLE DERMATOLOGY CENTER
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 36 NEWARK AVE SUITE 214
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City | BELLEVILLE
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State | NJ
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Zip | 07109-4119
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Country | US
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Telephone | 973-751-1200
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Fax | 973-450-9395
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Provider Business Mailing Address
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Address Line | 36 NEWARK AVE SUITE 214
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City | BELLEVILLE
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State | NJ
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Zip | 07109-4119
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Country | US
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Telephone | 973-751-1200
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Fax | 973-450-9395
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Authorized Official
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Title or Position | C.E.O.
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Name | JOSEPH SHELDON EASTERN
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Credential | M.D.
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Telephone | 973-751-1200
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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 | 25MA03902100
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License Number State | NJ
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