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NPI Code Detail

MEDICARE: 21ST CENTURY DERMATOLOGY,LLC

MEDICARE: 21ST CENTURY DERMATOLOGY,LLC
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
1174400000XSpecialistNJ

General Provider Information

NPI Number : 1649361643
Entity Type Code : Organization
Provider Name (Legal Business Name) : 21ST CENTURY DERMATOLOGY,LLC
Provider Business Mailing Address
First Line : 1 WEST RIDGEWOOD AVENUE
Second Line : SUITE 305
City : PARAMUS
State : NJ
Zip : 07652-2361
Country : US
Telephone Number : 201-445-8786
Fax Number : 201-445-8811
Provider Business Practice Location Address
First Line : 1 WEST RIDGEWOOD AVENUE
Second Line : SUITE 305
City : PARAMUS
State : NJ
Zip : 07652-2359
Country : US
Telephone Number : 201-445-8786
Fax Number : 201-445-8811
Authorized Official
Title or Position : OWNER/MD
Name : DR. MARCY GOLDSTEIN
Credential : MD
Telephone Number : 201-445-8786
Provider Enumeration Date : 09/27/2006
Last Update Date : 05/08/2013

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Directions to “21ST CENTURY DERMATOLOGY,LLC ” Practice Location

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