Healthcare Provider Details

I. General information

NPI: 1750559241
Provider Name (Legal Business Name): BROOKE MICHELE SKOLNICK D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 EISENHOWER PKWY STE 102
ROSELAND NJ
07068-1029
US

IV. Provider business mailing address

103 EISENHOWER PKWY STE 102
ROSELAND NJ
07068-1029
US

V. Phone/Fax

Practice location:
  • Phone: 973-288-2723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02349300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: