Provider Demographics
NPI:1053429720
Name:WINDSOR DERMATOLOGY PC
Entity type:Organization
Organization Name:WINDSOR DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-443-4500
Mailing Address - Street 1:59 ONE MILE ROAD
Mailing Address - Street 2:SUITE G
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520
Mailing Address - Country:US
Mailing Address - Phone:609-443-4500
Mailing Address - Fax:609-443-4808
Practice Address - Street 1:59 ONE MILE ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520
Practice Address - Country:US
Practice Address - Phone:609-443-4500
Practice Address - Fax:609-443-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty