Dermatology and Laser Center PA

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

25MA06221000 Issued in NJ

Legal business name

DERMATOLOGY AND LASER CENTER PA

Practice address

279 Third Avenue
Suite 603
Long Branch, NJ 07740-6205

Phone

(732) 222-8323

Fax

(732) 870-9488

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Benjamin Cohen, MDNPI 1053301085

Title

Owner

Phone

(732) 222-8323

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 3

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

• Benjamin Cohen

  • Dermatology Physician
  • Long Branch, NJ
  • NPI 1053301085
  Medicare reassignment Care Compare group NPD Authorized official
• Adele Haimovic, M.D.

  • Dermatology Physician
  • New York, NY
  • NPI 1518227800

  NJ

  Medicare reassignment Care Compare group NPD
• Kristin Horan, APN

  • Physician Assistant
  • Freehold, NJ
  • NPI 1467966523
  Medicare reassignment NPD

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457308800000",
    "number": "1780894428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18751",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071918751",
            "telephone_number": "732-222-8323",
            "fax_number": "732-870-9488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 THIRD AVENUE",
            "address_2": "SUITE 603",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077406205",
            "telephone_number": "732-222-8323",
            "fax_number": "732-870-9488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND LASER CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2016-03-07",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-222-8323",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NJ",
            "license": "25MA06221000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0675790000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hans Jesper Fletchetero Del Mundo, MD
• Maria Amanda Julian Dela Cruz, MD
• Dana Delatush
• Larry Dembrun
• Mark Jack Der Mesropian, D.O.
• Shiv Desai
• Tuisha Desai, D.O.
• Diagnostic Genetics
• Diagnostic Laboratoy Services
• Lisa Dille, EDD. BCBA

• Procedural Dermatology Physician in Long Branch, NJ
• Providers in Long Branch, NJ by specialty
• Procedural Dermatology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; 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.