Healthcare Provider Details

I. General information

NPI: 1770067126
Provider Name (Legal Business Name): SKIN CANCER AND COSMETIC SURGERY CENTER OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PARSONAGE RD STE 312
EDISON NJ
08837-2429
US

IV. Provider business mailing address

10 PARSONAGE RD STE 312
EDISON NJ
08837-2429
US

V. Phone/Fax

Practice location:
  • Phone: 908-227-5517
  • Fax:
Mailing address:
  • Phone: 908-227-5517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADRIANA LOMBARDI
Title or Position: OWNER
Credential: MD
Phone: 908-420-3933