{
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"EIN": null,
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"OrgName": "DERMATOLOGY ASSOCIATES OF DELAWARE VALLEY PC",
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"FirstLineMailingAddress": "3501 W CHESTER PIKE STE 202",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEWTOWN SQUARE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19073-3708",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-325-5553",
"MailingAddressFaxNumber": "610-325-5532",
"FirstLinePracticeLocationAddress": "3501 W CHESTER PIKE",
"SecondLinePracticeLocationAddress": "UNIT 205",
"PracticeLocationAddressCityName": "NEWTOWN SQUARE",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-325-5553",
"PracticeLocationAddressFaxNumber": "610-325-5532",
"EnumerationDate": "11/14/2006",
"LastUpdateDate": "11/01/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COCH BENSTOCK",
"AuthorizedOfficialFirstName": "DAPHNE",
"AuthorizedOfficialMiddleName": "ELIZABETH",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "610-325-5553",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207N00000X",
"TaxonomyName": "Dermatology Physician",
"LicenseNumber": "MD07523L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}