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General NPI Number Information
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NPI Number | 1255597902
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Entity Type | Organization
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Legal Business Name | REJUV-CENTER FOR COSMETIC REJUVENATION
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 59 MINE BROOK RD
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2496
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Country | US
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Telephone | 908-630-0007
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Fax | 908-630-9619
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Provider Business Mailing Address
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Address Line | 59 MINE BROOK RD
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2496
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Country | US
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Telephone | 908-630-0007
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Fax | 908-630-9619
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD E MARKI
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Credential | M.D.
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Telephone | 908-630-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MA052084
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License Number State | NJ
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