NPIMap

Organization Active NPI

Poblete Dermatology LLC

  • Dermatology Physician
  • Mercerville, NJ
National Provider Identifier
1013322932
Registry record updated Jun 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
POBLETE DERMATOLOGY LLC
Practice address
1601 Whitehorse Mercerville Rd
Suite 2
Mercerville, NJ 08619-3836
Phone
(732) 212-0051
NPI assigned
Jun 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Maria Veronica R Abello-Poblete, MDNPI 1366694416
Title
President
Phone
(732) 212-0051

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1601 Whitehorse Mercerville Rd
Suite 2
Mercerville, NJ 08619-3836

Mailing address

1601 Whitehorse Mercerville Rd
Suite 2
Mercerville, NJ 08619-3836
Phone (732) 212-0051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141016000915 NJ Part B Supplier - Clinic/Group Practice 5597986513 Receives reassigned benefits from 8 practitioners
Practice locations: Mercerville, NJ

National Provider Directory

National Provider Directory

Locations

1601 Whitehorse Mercerville Rd
Ste 2
Trenton, NJ 08619
Phone (609) 586-1313

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1013322932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 WHITEHORSE MERCERVILLE RD",
            "address_2": "SUITE 2",
            "city": "MERCERVILLE",
            "state": "NJ",
            "postal_code": "086193836",
            "telephone_number": "732-212-0051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 WHITEHORSE MERCERVILLE RD",
            "address_2": "SUITE 2",
            "city": "MERCERVILLE",
            "state": "NJ",
            "postal_code": "086193836",
            "telephone_number": "732-212-0051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POBLETE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-30",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "ABELLO-POBLETE",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "VERONICA R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-212-0051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mercerville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.