Provider Demographics
NPI:1386981884
Name:DERMATOLOGY & SKIN SURGERY CENTER OF PRINCETON LLC
Entity type:Organization
Organization Name:DERMATOLOGY & SKIN SURGERY CENTER OF PRINCETON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-799-6222
Mailing Address - Street 1:8 FORRESTAL RD S STE 202
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6658
Mailing Address - Country:US
Mailing Address - Phone:609-799-6222
Mailing Address - Fax:609-799-6555
Practice Address - Street 1:8 FORRESTAL RD S STE 202
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6658
Practice Address - Country:US
Practice Address - Phone:609-799-6222
Practice Address - Fax:609-799-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06571600207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty