Basic Information
| Provider Information | |||||||||
| NPI: | 1124185004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DERMATOLOGY PHYSICIANS OF SOUTH JERSEY, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 WHITE HORSE PIKE | ||||||||
| Address2: | RT. 30 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565468672 | ||||||||
| FaxNumber: | 8565465315 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 CENTURY PKWY STE 105 | ||||||||
| Address2: | |||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080541129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562060201 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | VELEZ | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8565468672 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DERMATOLOGY ASSOCIATES OF SOUTH JERSEY, LLC. | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
No ID Information.