NPIMap

Organization Active NPI

The Dermatology Clinic

  • Medical Specialty Clinic/Center
  • Manasquan, NJ
National Provider Identifier
1689015877
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
THE DERMATOLOGY CLINIC
Practice address
2315 Route 34
Manasquan, NJ 08736-1444
Phone
(650) 274-5513
NPI assigned
Jul 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

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

Authorized official

Name
Swarna Priya Sivanesan, M.DNPI 1104024165
Title
Owner
Phone
(650) 274-5513

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
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

2315 Route 34
Manasquan, NJ 08736-1444

Mailing address

PO Box 330
Hazlet, NJ 07730-0330
Phone (650) 274-5513

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131202000090 NJ Part B Supplier - Clinic/Group Practice 4981830601 Receives reassigned benefits from 5 practitioners
Practice locations: Freehold, NJ; Hazlet, NJ; West Long Branch, NJ

National Provider Directory

National Provider Directory

Locations

1 Bethany Rd
Ste 5
Hazlet, NJ 07730
Phone (732) 888-7734

1 Bethany Rd
Ste 67
Hazlet, NJ 07730
Phone (732) 222-2250

241 Monmouth Rd
Ste 101
West Long Branch, NJ 07764
Phone (732) 263-7922

107 Monmouth Rd
Ste 203
West Long Branch, NJ 07764
Phone (732) 222-2250

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1689015877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 330",
            "city": "HAZLET",
            "state": "NJ",
            "postal_code": "077300330",
            "telephone_number": "650-274-5513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 ROUTE 34",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "087361444",
            "telephone_number": "650-274-5513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DERMATOLOGY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "SIVANESAN",
        "authorized_official_first_name": "SWARNA",
        "authorized_official_middle_name": "PRIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-274-5513",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manasquan, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.