Healthcare Provider Details

I. General information

NPI: 1578099081
Provider Name (Legal Business Name): ADVANCED MEDICAL AND SKIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 HARRISTOWN RD
GLEN ROCK NJ
07452-3308
US

IV. Provider business mailing address

208 HARRISTOWN RD
GLEN ROCK NJ
07452-3308
US

V. Phone/Fax

Practice location:
  • Phone: 201-882-1050
  • Fax: 201-882-1040
Mailing address:
  • Phone: 201-882-1050
  • Fax: 201-882-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07806100
License Number StateNJ

VIII. Authorized Official

Name: DR. LUIS LUNA
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 201-882-1050