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General NPI Number Information
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NPI Number | 1487770905
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN DERMATOLOGY AND COSMETIC SURGERY THE MILLBURN LASER CENT
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 12 E WILLOW ST
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City | MILLBURN
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State | NJ
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Zip | 07041-1417
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Country | US
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Telephone | 973-376-8500
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Fax | 973-376-1820
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Provider Business Mailing Address
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Address Line | 12 EAST WILLOW STREET
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City | MILLBURN
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State | NJ
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Zip | 07041-1737
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Country | US
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Telephone | 973-376-8500
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Fax | 973-376-1820
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Authorized Official
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Title or Position | OWNER
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Name | ERIC SCOTT SIEGEL
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Credential | MD
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Telephone | 973-376-8500
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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 | MC68842
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License Number State | NJ
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