NPIMap

Organization Active NPI

Associated Dermatology

  • Dermatology Physician
  • Newton, NJ
National Provider Identifier
1376721373
Registry record updated Nov 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
25MB05321100 Issued in NJ
Legal business name
ASSOCIATED DERMATOLOGY
Practice address
136 Woodside Ave
Newton, NJ 07860
Phone
(973) 300-0555
Fax
(973) 300-0052
NPI assigned
Feb 1, 2008
Reactivated
Nov 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2008

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

Authorized official

Name
Dr. Martin Blackwell, DONPI 1356330534
Title
Physician
Phone
(973) 300-0555

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: 193200000X MULTI-SPECIALTY GROUP 207N00000X 25MB05321100 NJ Primary

Addresses

Primary practice location

136 Woodside Ave
Newton, NJ 07860

Mailing address

136 Woodside Avenue
Newton, NJ 07860
Phone (973) 300-0555

Other names 1

  • Dr. Martin Blackwell Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1376721373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 WOODSIDE AVENUE",
            "city": "NEWTON",
            "state": "NJ",
            "postal_code": "07860",
            "telephone_number": "973-300-0555",
            "fax_number": "973-300-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 WOODSIDE AVE",
            "city": "NEWTON",
            "state": "NJ",
            "postal_code": "07860",
            "telephone_number": "973-300-0555",
            "fax_number": "973-300-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2008-11-12",
        "deactivation_date": "2008-07-11",
        "reactivation_date": "2008-11-12",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "973-300-0555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "25MB05321100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Martin Blackwell",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2008; 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.