Provider Demographics
NPI:1962586586
Name:NEW AGE DERMATOLOGY INC
Entity type:Organization
Organization Name:NEW AGE DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-805-9399
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 3900
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-805-9399
Mailing Address - Fax:561-805-9866
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 3900
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-805-9399
Practice Address - Fax:561-805-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty