Basic Information
| Provider Information | |||||||||
| NPI: | 1336399112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASTROMONACO | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565465353 | ||||||||
| FaxNumber: | 8565465315 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565465353 | ||||||||
| FaxNumber: | 8565465315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 09/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 05010384 | PA | N | Other Service Providers | Specialist | 174400000X | 25MB06489100 | NJ | N | Other Service Providers | Specialist | 207N00000X | 25MB06489100 | NJ | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.