Healthcare Provider Details

I. General information

NPI: 1730207796
Provider Name (Legal Business Name): DAVID SKOLNIK OTR, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E BROAD ST
WESTFIELD NJ
07090-2116
US

IV. Provider business mailing address

502 E BROAD ST
WESTFIELD NJ
07090-2116
US

V. Phone/Fax

Practice location:
  • Phone: 908-654-8500
  • Fax: 908-654-1327
Mailing address:
  • Phone: 908-654-8500
  • Fax: 908-654-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number46TR00086600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: