NPIMap

Organization Active NPI

Dermatology Associates of Central New Jersey, PA

  • MOHS-Micrographic Surgery Physician
  • Old Bridge, NJ
National Provider Identifier
1104950013
Registry record updated Jan 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
DERMATOLOGY ASSOCIATES OF CENTRAL NEW JERSEY, PA
Practice address
3548 Route 9
Suite 2
Old Bridge, NJ 08857-2765
Phone
(732) 679-6300
Fax
(732) 679-9566
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2016

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

Authorized official

Name
Ms. Grace Centurion, M.D.
Title
Office Manager
Phone
(732) 679-6738

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X Primary

Addresses

Primary practice location

3548 Route 9
Suite 2
Old Bridge, NJ 08857-2765

Mailing address

3548 Route 9
Suite 2
Old Bridge, NJ 08857-2765
Phone (732) 679-6300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060109000814 NJ Part B Supplier - Clinic/Group Practice 4688697394 Receives reassigned benefits from 14 practitioners
Practice locations: Freehold, NJ; Union, NJ; Toms River, NJ; Old Bridge, NJ

National Provider Directory

National Provider Directory

Locations

57 Schanck Rd
Ste C-6
Freehold, NJ 07728
Phone (732) 679-6300

57 Schanck Rd
Ste C-7
Freehold, NJ 07728
Phone (732) 679-6300

250 South St
Freehold, NJ 07728
Phone (732) 780-7870

28 Throckmorton Ln
Ste 204
Old Bridge, NJ 08857
Phone (732) 679-6300

3548 US Highway 9
Ste 2
Old Bridge, NJ 08857
Phone (732) 679-6300

440 Chestnut St
Ste 1
Union, NJ 07083
Phone (732) 679-6300

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453420800000",
    "number": "1104950013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3548 ROUTE 9",
            "address_2": "SUITE 2",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088572765",
            "telephone_number": "732-679-6300",
            "fax_number": "732-679-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3548 ROUTE 9",
            "address_2": "SUITE 2",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088572765",
            "telephone_number": "732-679-6300",
            "fax_number": "732-679-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF CENTRAL NEW JERSEY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2016-01-22",
        "status": "A",
        "authorized_official_last_name": "CENTURION",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "732-679-6738",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Old Bridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; 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.