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General NPI Number Information
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NPI Number | 1720931801
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Entity Type | Organization
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Legal Business Name | EPIPHANY DERMATOLOGY OF NEW JERSEY LLC
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 1200 ROUTE 22 E.
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2943
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Country | US
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Telephone | 973-267-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 RANCH ROAD 2222, BLDG 1, STE 200
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City | AUSTIN
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State | TX
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Zip | 78730-3255
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Country | US
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Telephone | 512-628-0465
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Fax | 512-233-2711
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Authorized Official
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Title or Position | SECRETARY
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Name | GHEORGHE PUSTA
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Credential |
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Telephone | 512-628-0465
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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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