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IMAGE DERMATOLOGY PC
NPI 1104027556
Specialist in Montclair, NJ

Active since May 31, 2007CLIA 31D2094278 · Waiver
51 PARK ST, MONTCLAIR, NJ 07042(973) 509-6900(973) 509-6939 Get Directions Write a Review

NPPES record last updated: January 24, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Image Dermatology Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IMAGE DERMATOLOGY PC (NPI 1104027556) is a healthcare organization registered as a specialist in Montclair, New Jersey and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through April 13, 2027 and lists Jeanine B. Downie, Owner, as its authorized official.

NPPES Registry Identity

NPI1104027556
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameIMAGE DERMATOLOGY PC
Location Address51 PARK STMontclair, NJ 07042-3439
Mailing Address51 Park StMontclair, NJ 07042-3439 · (973) 509-6900 · Fax (973) 509-6939
Phone(973) 509-6900
Fax(973) 509-6939
Organization SubpartNo
Authorized OfficialJeanine B. DownieOwner · (973) 509-6900
Enumeration DateMay 31, 2007
Last NPPES UpdateJanuary 24, 2008
✔ NPI 1104027556 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NJ · MA65931
Definition

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.

51 PARK ST, Montclair, NJ 07042
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Other Identifiers 2

Medicare PIN951568NJ
Medicare UPING51843NJ

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D2094278

Image Dermatology, PC · Montclair, NJ
Active · expires Apr 13, 2027
CLIA Number31D2094278
Laboratory TypePhysician Office
Certificate Effective DateApril 14, 2025
Certificate Expiration DateApril 13, 2027
Laboratory DirectorJeanine B. Downie
Laboratory Phone(973) 509-6900
Laboratory LocationImage Dermatology, PC51 Park Street, Montclair, NJ 07042
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. JENNIFER GOLDBERG PA
Physician Assistant
51 PARK ST
MONTCLAIR, NJ 07042
Essex County (973) 509-6900
DR. JEANINE B. DOWNIE M. D.
Dermatology
51 PARK ST
MONTCLAIR, NJ 07042
Essex County (973) 509-6900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Image Dermatology PC's NPI number?

The NPI number for Image Dermatology PC is 1104027556. It was assigned to this organization in the NPPES registry on May 31, 2007.

Where is Image Dermatology PC located?

Image Dermatology PC is located at 51 Park St, Montclair, NJ 07042. The listed phone number is (973) 509-6900.

What is Image Dermatology PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Image Dermatology PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D2094278) is associated with this NPI, valid through April 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Image Dermatology PC was last updated on January 24, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.