Healthcare Provider Details

I. General information

NPI: 1881913713
Provider Name (Legal Business Name): MARGARITA LOLIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 702
HACKENSACK NJ
07601-1974
US

IV. Provider business mailing address

33 E 33RD ST FL 12
NEW YORK NY
10016-5362
US

V. Phone/Fax

Practice location:
  • Phone: 844-337-6362
  • Fax: 646-665-3604
Mailing address:
  • Phone: 844-337-6362
  • Fax: 646-665-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number25MA09320800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: