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General NPI Number Information
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NPI Number | 1184651440
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Entity Type | Organization
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Legal Business Name | LIVINGSTON DERMATOLOGY ASSOCIATES
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 201 S LIVINGSTON AVE SUITE 1F
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4043
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Country | US
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Telephone | 973-994-1170
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S LIVINGSTON AVE SUITE 1F
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4043
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Country | US
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Telephone | 973-994-1170
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROL BLEKA
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Credential |
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Telephone | 973-994-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State | NJ
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