IMAGE DERMATOLOGY PC NPI 1104027556

NPI Information

  • NPI: 1104027556
  • Provider Name: IMAGE DERMATOLOGY PC
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 31D2094278
  • Address: 51 PARK ST
    MONTCLAIR, NJ
    ZIP 07042
  • Phone: (973) 509-6900

Map and Directions

Get Directions

NPI Details

IMAGE DERMATOLOGY PC is a specialist in Montclair, NJ. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. IMAGE DERMATOLOGY PC NPI is 1104027556. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

51 PARK ST
MONTCLAIR, NJ
ZIP 07042-439
Phone: (973) 509-6900
Fax: (973) 509-6939

The provider's authorized official is Jeanine B. Downie .
The authorized official title is Owner and has the following contact phone number (973) 509-6900.

The CLIA number assigned to this NPI record is 31D2094278 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/31/2007 and was last updated on 1/24/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistMA65931NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1951568MEDICARE PINNEW JERSEY
2G51843MEDICARE UPINNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI