NPIMap

Organization Active NPI

Laser & Skin Therapeutics PC

  • Dermatology Physician
  • Chatham, NJ
National Provider Identifier
1912191230
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
25MA07719400 Issued in NJ
Legal business name
LASER & SKIN THERAPEUTICS PC
Practice address
33 Main St
Suite 103
Chatham, NJ 07928-2433
Phone
(973) 635-5050
Fax
(973) 635-4567
NPI assigned
Aug 29, 2007
Last updated
Oct 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Lisa M. Coppa, M.D.
Title
Owner
Phone
(973) 635-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 25MA07719400 NJ Primary

Addresses

Primary practice location

33 Main St
Suite 103
Chatham, NJ 07928-2433

Mailing address

33 Main St
Suite 103
Chatham, NJ 07928-2433
Phone (973) 635-5050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070927000708 NJ Part B Supplier - Clinic/Group Practice 9234224874 Receives reassigned benefits from 5 practitioners
Practice locations: Chatham, NJ

National Provider Directory

National Provider Directory

Locations

417 Main St
Chatham, NJ 07928
Phone (973) 635-2290

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1912191230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 MAIN ST",
            "address_2": "SUITE 103",
            "city": "CHATHAM",
            "state": "NJ",
            "postal_code": "079282433",
            "telephone_number": "973-635-5050",
            "fax_number": "973-635-4567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 MAIN ST",
            "address_2": "SUITE 103",
            "city": "CHATHAM",
            "state": "NJ",
            "postal_code": "079282433",
            "telephone_number": "973-635-5050",
            "fax_number": "973-635-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASER & SKIN THERAPEUTICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-29",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "COPPA",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-635-5050",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "25MA07719400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chatham, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.