Healthcare Provider Details

I. General information

NPI: 1174637722
Provider Name (Legal Business Name): KUFLIK DERMATOLOGY, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 LAKEHURST RD
TOMS RIVER NJ
08755-6342
US

IV. Provider business mailing address

453 LAKEHURST RD
TOMS RIVER NJ
08755-6342
US

V. Phone/Fax

Practice location:
  • Phone: 732-341-0515
  • Fax: 732-240-0933
Mailing address:
  • Phone: 732-341-0515
  • Fax: 732-240-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AVERY KUFLIK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-341-0515