NPIMap

Organization Active NPI

Dermone Dermatology Associates of the Garden State, PC

  • MOHS-Micrographic Surgery Physician
  • Freehold, NJ
National Provider Identifier
1053771048
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
DERMONE DERMATOLOGY ASSOCIATES OF THE GARDEN STATE, PC
Practice address
501 Iron Bridge Road
Freehold, NJ 07728
Phone
(800) 337-6663
Fax
(732) 731-6135
NPI assigned
Mar 3, 2016
Last updated
Feb 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Authorized official

Name
Jeffrey J Petrick
Title
Chief Financial & Admin. Officer
Phone
(484) 240-6550

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X Primary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X
Pediatric Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NP0225X
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

501 Iron Bridge Road
Freehold, NJ 07728

Mailing address

Four Tower Bridge, 200 Barr Harbor Dr
Suite 200
West Conshohocken, PA 19428-1518
Phone (848) 240-2812

National Provider Directory

National Provider Directory

Locations

4450 Black Horse Pike
Ste 3979
Mays Landing, NJ 08330

368 Lakehurst Rd
Ste 201
Toms River, NJ 08755
Phone (732) 505-1500

67 Lacey Rd
Ste 2
Whiting, NJ 08759
Phone (732) 350-1188

8700 Freeport Pkwy
Ste 120
Irving, TX 75063

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1053771048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FOUR TOWER BRIDGE, 200 BARR HARBOR DR",
            "address_2": "SUITE 200",
            "city": "WEST CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194281518",
            "telephone_number": "848-240-2812",
            "fax_number": "732-731-6135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 IRON BRIDGE ROAD",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "07728",
            "telephone_number": "800-337-6663",
            "fax_number": "732-731-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMONE DERMATOLOGY ASSOCIATES OF THE GARDEN STATE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-03",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "PETRICK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL & ADMIN. OFFICER",
        "authorized_official_telephone_number": "484-240-6550"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.