Basic Information
| Provider Information | |||||||||
| NPI: | 1831197474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW ENGLAND DERMATOLOGY ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 357 HARTFORD TPKE | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060664838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608719441 | ||||||||
| FaxNumber: | 8608710227 | ||||||||
| Practice Location | |||||||||
| Address1: | 357 HARTFORD TPKE | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060664838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608719441 | ||||||||
| FaxNumber: | 8608710227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GREENBERG | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8608719441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.