Basic Information
| Provider Information | |||||||||
| NPI: | 1912100470 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADULT AND PEDIATRIC DERMATOLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 385 ROUTE 18 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323901883 | ||||||||
| FaxNumber: | 7329071711 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 ROUTE 18 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323901883 | ||||||||
| FaxNumber: | 7329071711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 07/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHRAGA | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7323901883 | ||||||||
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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 | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.