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General NPI Number Information
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NPI Number | 1932347507
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Entity Type | Organization
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Legal Business Name | CENTRAL JERSEY SKIN CARE ASSOCIATES, P.A.
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 1125 SAINT GEORGES AVE
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City | RAHWAY
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State | NJ
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Zip | 07065-2631
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Country | US
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Telephone | 732-499-0440
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Fax | 732-499-0225
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Provider Business Mailing Address
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Address Line | 1125 ST. GEORGES AVE.
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City | RAHWAY
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State | NJ
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Zip | 07065
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Country | US
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Telephone | 732-499-0440
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Fax | 732-499-0225
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON G WININGER
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Credential | M.D.
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Telephone | 732-499-0440
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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 | MA035301
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License Number State | NJ
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