Michael J Decosmo DO PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

25MB02598600 Issued in NJ

Legal business name

MICHAEL J DECOSMO DO PA

Practice address

2201 Chapel Ave West
Suite 102
Cherry Hill, NJ 08002

Phone

(856) 662-7883

Fax

(856) 662-5838

NPI assigned

Mar 1, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Michael Joseph Decosmo, DO

Title

President

Phone

(856) 662-7883

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1298937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298937600000",
    "number": "1689972606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 CHAPEL AVE WEST",
            "address_2": "SUITE 102",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "08002",
            "telephone_number": "856-662-7883",
            "fax_number": "856-662-5838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 CHAPEL AVE WEST",
            "address_2": "SUITE 102",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "08002",
            "telephone_number": "856-662-7883",
            "fax_number": "856-662-5838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J DECOSMO DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-01",
        "last_updated": "2011-03-01",
        "status": "A",
        "authorized_official_last_name": "DECOSMO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-662-7883",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "25MB02598600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Cherry Hill, NJ
• Providers in Cherry Hill, NJ by specialty
• Dermatology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; 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.