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Organization
PARK DERMATOLOGY ASSOC PC
Active
Organization
PARK DERMATOLOGY ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY M RITT MD (PHYSICIAN)
(508) 894-5100
Entity
Organization
Contact information
Practice address
ONE PEARL ST, STE 2300, BROCKTON, MA 02301
(508) 894-5100
(508) 894-5111
Mailing address
ONE PEARL ST, STE 2300, BROCKTON, MA 02301
(508) 894-5100
(508) 894-5111
Taxonomy
Speciality
Code
Description
License number
State
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
Primary
—
NULL
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9717404
—
MA
Enumeration date
07/20/2006
Last updated
02/12/2008
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