NPIMap

Organization Active NPI

Dermatology Center of Washington Township PC

  • Dermatology Physician
  • Sewell, NJ
National Provider Identifier
1508953035
Registry record updated Mar 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY CENTER OF WASHINGTON TOWNSHIP PC
Practice address
100 Kings Way E Ste A3
Washington Pavilions
Sewell, NJ 08080-2237
Phone
(856) 589-3331
Fax
(856) 589-3416
NPI assigned
Oct 6, 2006
Last updated
Mar 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2015

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

Authorized official

Name
Jonathan M Winter, MDNPI 1922028950
Title
Physician President
Phone
(856) 589-3331

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X

Addresses

Primary practice location

100 Kings Way E Ste A3
Washington Pavilions
Sewell, NJ 08080-2237

Mailing address

100 Kings Way E Ste A3
Washington Pavilions
Sewell, NJ 08080-2237
Phone (856) 589-3331

Other identifiers 3

IdentifierTypeStateIssuer
2423791OtherAETNA
CJ2498OtherNJRR MEDICARE
0112030000OtherIBC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050720000701 NJ Part B Supplier - Clinic/Group Practice 2769419860 Receives reassigned benefits from 10 practitioners
Practice locations: Sewell, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0119315Dermatology Center of Washington Township PC100 Kings Way East, Sewell, NJ 08080ComplianceOct 7, 2026

National Provider Directory

National Provider Directory

Locations

100 Kings Way E
Ste A1
Sewell, NJ 08080
Phone (856) 589-3331

Practitioners & affiliated clinicians

Practitioners 10

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426550400000",
    "number": "1508953035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KINGS WAY E STE A3",
            "address_2": "WASHINGTON PAVILIONS",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802237",
            "telephone_number": "856-589-3331",
            "fax_number": "856-589-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KINGS WAY E STE A3",
            "address_2": "WASHINGTON PAVILIONS",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802237",
            "telephone_number": "856-589-3331",
            "fax_number": "856-589-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER OF WASHINGTON TOWNSHIP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2015-03-17",
        "status": "A",
        "authorized_official_last_name": "WINTER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN PRESIDENT",
        "authorized_official_telephone_number": "856-589-3331",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2423791",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CJ2498",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC",
            "identifier": "0112030000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewell, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.