Family Skin Care Center LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

25MP00229400 Issued in NJ

Legal business name

FAMILY SKIN CARE CENTER LLC

Practice address

17 White Horse Pike Suite 10B
Haddon Height, NJ 08035

Phone

(856) 340-9128

NPI assigned

Sep 4, 2017

Last updated

Jun 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Anamaria Newport, DMS, MHS, PACNPI 1386972321

Title

Owner

Phone

(856) 340-9128

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

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.

• Anamaria Newport, P.A.-C

  • Medical Physician Assistant
  • Haddon Heights, NJ
  • NPI 1386972321
  Medicare reassignment Authorized official
• Pavani Gunda, M.D.

  • Internal Medicine Physician
  • Stratford, NJ
  • NPI 1750572640
  Medicare reassignment NPD

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

{
    "created_epoch": "1504483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1104344738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 WESTFIELD RD",
            "city": "MORRESTOWN",
            "state": "NJ",
            "postal_code": "08057",
            "telephone_number": "856-340-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WHITE HORSE PIKE SUITE 10B",
            "city": "HADDON HEIGHT",
            "state": "NJ",
            "postal_code": "08035",
            "telephone_number": "856-340-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SKIN CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-04",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "NEWPORT",
        "authorized_official_first_name": "ANAMARIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-340-9128",
        "authorized_official_credential": "DMS, MHS, PAC"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "25MP00229400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.