MEDICARE: DERMATOLOGY PHYSICIANS OF SOUTH JERSEY, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0900X	Dermatopathology Physician		NJ

General Provider Information

NPI Number	:	1124185004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY PHYSICIANS OF SOUTH JERSEY, PA

Provider Business Mailing Address
First Line	:	112 WHITE HORSE PIKE
Second Line	:	RT. 30
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1908
Country	:	US
Telephone Number	:	856-546-8672
Fax Number	:	856-546-5315

Provider Business Practice Location Address
First Line	:	150 CENTURY PKWY STE 105
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1129
Country	:	US
Telephone Number	:	856-206-0201
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JOSEPH ANTHONY VELEZ
Credential	:
Telephone Number	:	856-546-8672

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	12/16/2020

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