Healthcare Provider Details

I. General information

NPI: 1922001650
Provider Name (Legal Business Name): ADRIAN L CONNOLLY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OLD SHORT HILLS RD STE 503
WEST ORANGE NJ
07052-1023
US

IV. Provider business mailing address

201 S LIVINGSTON AVE STE 1C
LIVINGSTON NJ
07039-4040
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-9131
  • Fax: 973-731-9201
Mailing address:
  • Phone: 908-509-1938
  • Fax: 856-543-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMA036148
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMA036148
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMA036148
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: