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General NPI Number Information
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NPI Number | 1285047209
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Entity Type | Organization
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Legal Business Name | CARLA V. ERRICKSON, MD
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 65 CONGRESSIONAL BLVD
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City | WASHINGTON
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State | NJ
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Zip | 07882-1525
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Country | US
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Telephone | 908-689-1341
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Fax |
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Provider Business Mailing Address
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Address Line | 65 CONGRESSIONAL BLVD
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City | WASHINGTON
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State | NJ
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Zip | 07882-1525
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Country | US
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Telephone | 908-689-1341
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Fax |
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | DR. CARLA V ERRICKSON
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Credential | MD
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Telephone | 908-689-1341
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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 | 25MA06680700
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License Number State | NJ
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