Organization
N J DERMATOPATHOLOGY
Active
Organization
N J DERMATOPATHOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY ROTHENBERG MD (MEDICAL DIRECTOR)
(973) 669-0141
Entity
Organization
Contact information
Practice address
769 NORTHFIELD AVE STE LL30, WEST ORANGE, NJ 07052
(973) 669-0141
(973) 669-8220
Mailing address
769 NORTHFIELD AVE STE LL30, WEST ORANGE, NJ 07052
(973) 669-0141
(973) 669-8220
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
25MA03949600.
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1220021085
RR MEDICARE
NJ
05
—
3300609
—
NJ
Enumeration date
11/17/2006
Last updated
03/30/2010
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