Provider Demographics
NPI:1063144715
Name:DERMATOLOGY INSTITUTE OF PRINCETON LLC
Entity type:Organization
Organization Name:DERMATOLOGY INSTITUTE OF PRINCETON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DABELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-222-4702
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528-0588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 EWING ST STE C3
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2756
Practice Address - Country:US
Practice Address - Phone:609-269-4957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty