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General NPI Number Information
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NPI Number | 1932215142
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CENTER OF RIDGEWOOD, LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 1 SEARS DR
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City | PARAMUS
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State | NJ
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Zip | 07652-3515
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Country | US
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Telephone | 201-265-2994
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Fax | 201-265-2294
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Provider Business Mailing Address
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Address Line | 1 SEARS DR
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City | PARAMUS
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State | NJ
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Zip | 07652-3515
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Country | US
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Telephone | 201-265-2994
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Fax | 201-265-2294
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRIS H KOPELOFF
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Credential | M.D.
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Telephone | 201-444-5667
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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 | 25MA05983500
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License Number State | NJ
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