Provider Demographics
NPI:1104950013
Name:DERMATOLOGY ASSOCIATES OF CENTRAL NEW JERSEY, PA
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF CENTRAL NEW JERSEY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTURION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-679-6738
Mailing Address - Street 1:3548 ROUTE 9
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2765
Mailing Address - Country:US
Mailing Address - Phone:732-679-6300
Mailing Address - Fax:732-679-9566
Practice Address - Street 1:3548 ROUTE 9
Practice Address - Street 2:SUITE 2
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2765
Practice Address - Country:US
Practice Address - Phone:732-679-6300
Practice Address - Fax:732-679-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ107968Medicare UPIN
NJC53742Medicare UPIN