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General NPI Number Information
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NPI Number | 1104211762
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Entity Type | Individual
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Provider Name | DR. MERLIN THERESA KURIAKOSE
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Gender | Female
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 05/21/2022
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Provider Practice Location Address
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Address Line | 84 MAPLE AVE STE A
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City | MORRISTOWN
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State | NJ
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Zip | 07960-9442
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Country | US
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Telephone | 973-524-7702
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Fax |
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Provider Business Mailing Address
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Address Line | 75 PARK GATE DR
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City | EDISON
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State | NJ
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Zip | 08820-4033
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Country | US
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Telephone | 973-524-7702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02628600
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License Number State | NJ
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