Provider Demographics
NPI:1194091884
Name:ACCREDITED DERMATOLOGY DELAWARE
Entity type:Organization
Organization Name:ACCREDITED DERMATOLOGY DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:E
Authorized Official - Last Name:GEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-731-6118
Mailing Address - Street 1:1580 LAKEWOOD RD
Mailing Address - Street 2:UNIT 16B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3287
Mailing Address - Country:US
Mailing Address - Phone:732-731-6118
Mailing Address - Fax:732-244-8482
Practice Address - Street 1:1580 LAKEWOOD RD
Practice Address - Street 2:UNIT 16B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-3287
Practice Address - Country:US
Practice Address - Phone:732-731-6118
Practice Address - Fax:732-244-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009601207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty