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General NPI Number Information
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NPI Number | 1518310366
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Entity Type | Organization
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Legal Business Name | SKIN & LASER CENTER OF NJ, LLC
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 500 N FRANKLIN TPKE STE 318
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City | RAMSEY
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State | NJ
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Zip | 07446-1160
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Country | US
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Telephone | 201-500-7525
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Fax | 201-500-7527
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Provider Business Mailing Address
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Address Line | 500 N FRANKLIN TPKE STE 318
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City | RAMSEY
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State | NJ
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Zip | 07446-1160
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Country | US
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Telephone | 201-500-7525
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Fax | 201-500-7527
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JOCELYN LIEB
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Credential | MD
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Telephone | 201-500-7525
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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 | 25MA08780100
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License Number State | NJ
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