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General NPI Number Information
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NPI Number | 1427355825
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Entity Type | Organization
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Legal Business Name | COSMETIC AND DERMATOLOGIC SURGERY ASSOCIATES LLC
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 719 N BEERS ST SUITE 2G
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City | HOLMDEL
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State | NJ
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Zip | 07733-1522
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Country | US
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Telephone | 802-310-0664
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Fax |
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Provider Business Mailing Address
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Address Line | 8 RIVERSIDE LN
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City | HOLMDEL
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State | NJ
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Zip | 07733-2084
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Country | US
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Telephone | 802-310-0664
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MANOJ THAKKER
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Credential | M.D.
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Telephone | 802-310-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA08673200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | 25MA08673200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 25MA08829200
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License Number State | NJ
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