Organization
ADULT AND PEDIATRIC DERMATOLOGY PRACTITIONERS P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY T. MASESSA (PRESIDENT)
(973) 625-0600
Entity
Organization
Contact information
Practice address
13005 SOUTHERN BLVD STE 224, LOXAHATCHEE, FL 33470-9272
(561) 793-2929
(561) 790-7568
Mailing address
35 GREEN POND RD STE C, ROCKAWAY, NJ 07866-2057
(973) 625-0600
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA851
MEDICARE
FL
Enumeration date
07/27/2021
Last updated
07/27/2021
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