Provider Demographics
NPI:1528640786
Name:CONTEMPORARY DERMATOLOGY LLC
Entity type:Organization
Organization Name:CONTEMPORARY DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-704-5557
Mailing Address - Street 1:159 UPPER MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1905
Mailing Address - Country:US
Mailing Address - Phone:201-704-5557
Mailing Address - Fax:
Practice Address - Street 1:3880 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-1855
Practice Address - Country:US
Practice Address - Phone:201-704-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty