Organization
DERMONE DERMATOLOGY ASSOCIATES OF THE GARDEN STATE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY J PETRICK (CHIEF FINANCIAL & ADMIN. OFFICER)
(484) 240-6550
Entity
Organization
Contact information
Practice address
501 IRON BRIDGE ROAD, FREEHOLD, NJ 07728
(800) 337-6663
(732) 731-6135
Mailing address
FOUR TOWER BRIDGE, 200 BARR HARBOR DR, SUITE 200, WEST CONSHOHOCKEN, PA 19428-1518
(848) 240-2812
(732) 731-6135
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
03/03/2016
Last updated
02/27/2017
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