NPIMap

Organization Active NPI

Dermatology Associates of South Jersey, L.L.C.

  • Dermatopathology Physician
  • Mount Laurel, NJ
National Provider Identifier
1699960096
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
25MA07815500 Issued in NJ
Legal business name
DERMATOLOGY ASSOCIATES OF SOUTH JERSEY, L.L.C.
Practice address
150 Century Pkwy Ste 150
Mount Laurel, NJ 08054-1129
Phone
(856) 206-0201
Fax
(856) 206-0209
NPI assigned
Sep 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Authorized official

Name
Dr. Carrie Ann Rishko Cusack, M.D.NPI 1649238775
Title
Physician/Owner
Phone
(856) 206-0201

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
Dermatopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0900X 25MA07815500 NJ Primary

Addresses

Primary practice location

150 Century Pkwy Ste 150
Mount Laurel, NJ 08054-1129

Mailing address

150 Century Pkwy Ste 105
Mount Laurel, NJ 08054-1129
Phone (856) 206-0201

Other practice location 1

112 White Horse Pike
Haddon Heights, NJ 08035-1908
Phone (856) 546-5353

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071204000443 NJ Part B Supplier - Clinic/Group Practice 7113016858 Receives reassigned benefits from 10 practitioners
Practice locations: Mount Laurel, 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
31D0695812Dermatology Associates of South Jersey112 White Horse Pike, Haddon Heights, NJ 08035ComplianceOct 20, 2026
31D2027817Dermatology Associates of South Jersey, LLC150 Century Parkway, Mount Laurel, NJ 08054ComplianceApr 18, 2028

National Provider Directory

National Provider Directory

Locations

715 Fellowship Rd
Ste B
Mount Laurel, NJ 08054
Phone (856) 206-0201

150 Century Pkwy
Ste 150
Mount Laurel, NJ 08054
Phone (856) 206-0201

150 Century Pkwy
Ste C
Mount Laurel, NJ 08054
Phone (856) 608-8860

Practitioners & affiliated clinicians

Practitioners 12

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": "1189296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1699960096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 CENTURY PKWY STE 105",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541129",
            "telephone_number": "856-206-0201",
            "fax_number": "856-206-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 CENTURY PKWY STE 150",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541129",
            "telephone_number": "856-206-0201",
            "fax_number": "856-206-0209"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 White Horse Pike",
            "address_purpose": "LOCATION",
            "city": "Haddon Heights",
            "state": "NJ",
            "postal_code": "080351908",
            "country_code": "US",
            "telephone_number": "856-546-5353",
            "fax_number": "856-546-8711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF SOUTH JERSEY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-09",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "CARRIE ANN",
        "authorized_official_middle_name": "RISHKO",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "856-206-0201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "NJ",
            "license": "25MA07815500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Laurel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.