Clearsolutions Dermatology Group New Jersey

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CLEARSOLUTIONS DERMATOLOGY GROUP NEW JERSEY

Practice address

402 Lacey Rd.
Unit C
Manchester Township, NJ 08759

Phone

(877) 425-7756

NPI assigned

Sep 19, 2023

Last updated

Jan 24, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jason Staback, PA-C, MSNPI 1750331948

Title

Ceo

Phone

(732) 991-6579

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 7

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.

• Jason Staback, PA-C

  • Dermatology Physician
  • Lewes, DE
  • NPI 1750331948

  NJ

  Medicare reassignment Care Compare group Authorized official
• David De Vinck, D.O.

  • Dermatopathology Physician
  • New York, NY
  • NPI 1205095155

  NJ

  Medicare reassignment Care Compare group NPD
• Pradip Bhattacharjee, M.D.

  • Dermatopathology (Pathology) Physician
  • Holmdel, NJ
  • NPI 1124351747
  Medicare reassignment NPD
• Robert Lee, M.D.

  • Dermatology Physician
  • Toms River, NJ
  • NPI 1801180807
  Medicare reassignment NPD
• Anthony Marion, PA-C

  • Physician Assistant
  • Barnegat, NJ
  • NPI 1609313048
  Medicare reassignment
• Lara T Bakhtiarian, PA-C

  • Physician Assistant
  • Brick, NJ
  • NPI 1710893854
  NPD (past)
• Maya Nicole Font

  • Physician Assistant
  • Brick, NJ
  • NPI 1508738378
  NPD (past)

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1831977024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 MOONLIGHT DR",
            "city": "COLTS NECK",
            "state": "NJ",
            "postal_code": "077221074",
            "telephone_number": "732-991-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 LACEY RD.",
            "address_2": "UNIT C",
            "city": "MANCHESTER TOWNSHIP",
            "state": "NJ",
            "postal_code": "08759",
            "telephone_number": "877-425-7756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARSOLUTIONS DERMATOLOGY GROUP NEW JERSEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-19",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "STABACK",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "732-991-6579",
        "authorized_official_credential": "PA-C, MS"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Lynn Agro
• Audiology Services Company USA, LLC
• Anuj Ramesh Bambhrolia
• Erin M Christiansen, NP

• Dermatology Physician in Manchester Township, NJ
• Providers in Manchester Township, 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 Jan 24, 2024; 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.