Modern Dermatology and Cosmetic Center LLC
Organization Active NPI Dermatology Physician · Wall, NJ
NPI 1376230581 · NPPES record last updated Apr 18, 2023
Key facts
- NPI
- 1376230581
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- MODERN DERMATOLOGY AND COSMETIC CENTER LLC
- Practice address
- 2510 Belmar Blvd
Wall, NJ 07719-3948 - Phone
- (908) 391-1694
- NPI assigned
- Apr 18, 2023
- Organization subpart
- No
Authorized official
- Name
- Iris Hatziminas
- Title
- Owner
- Phone
- (908) 391-1694
Practitioners 1
-
Iris Dubetsky, P.A.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230725001302 | NJ | Part B Supplier - Clinic/Group Practice | 9133580038 |
Receives reassigned benefits from 1 practitioner Practice locations: Wall, NJ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
2510 Belmar Blvd
Wall, NJ 07719-3948
Mailing address
2510 Belmar Blvd
Wall, NJ 07719-3948
Other providers in Wall, NJ
- Catherine L Meli
- Meridian Nursing and Rehabilitation, Inc.
- Matthew R Miller
- Gregory Matthew Minnis
- Pamela A Minnis
- Cindy Monsen-Gorto
- Kim H Morales
- New Jersey CVS Pharmacy LLC
- New Jersey Maxillofacial Digital Imaging Center
- New Jersey Psychiatric Clinic
All providers in Wall, NJ · Dermatology Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.