Basic Information
| Provider Information | |||||||||
| NPI: | 1194091884 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCREDITED DERMATOLOGY DELAWARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1580 LAKEWOOD RD | ||||||||
| Address2: | UNIT 16B | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087553287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327316118 | ||||||||
| FaxNumber: | 7322448482 | ||||||||
| Practice Location | |||||||||
| Address1: | 1580 LAKEWOOD RD | ||||||||
| Address2: | UNIT 16B | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087553287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327316118 | ||||||||
| FaxNumber: | 7322448482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | GEFFNER | ||||||||
| AuthorizedOfficialFirstName: | RAMI | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7327316118 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | C1-0009601 | DE | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.