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General NPI Number Information
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NPI Number | 1427115229
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Entity Type | Organization
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Legal Business Name | MONTVILLE DERMATOLOGY AND LASER CENTER
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 350 MAIN RD SUITE - 103
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City | MONTVILLE
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State | NJ
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Zip | 07045-9222
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Country | US
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Telephone | 973-402-1563
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Fax |
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Provider Business Mailing Address
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Address Line | 350 MAIN RD SUITE - 103
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City | MONTVILLE
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State | NJ
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Zip | 07045-9222
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Country | US
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Telephone | 973-402-1563
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL ROSS BILKIS
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Credential | MD
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Telephone | 973-402-1563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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