Organization
MODERN DERMATOLOGY AND COSMETIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRIS HATZIMINAS (OWNER)
(908) 391-1694
Entity
Organization
Contact information
Practice address
2510 BELMAR BLVD, WALL, NJ 07719-3948
(908) 391-1694
Mailing address
2510 BELMAR BLVD, WALL, NJ 07719-3948
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
04/18/2023
Last updated
04/18/2023
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