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General NPI Number Information
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NPI Number | 1518900810
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND LASER CENTER OF NORTHERN NEW JERSEY LLC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 290 S LIVINGSTON AVE SUITE 1
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3931
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Country | US
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Telephone | 973-740-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 290 S LIVINGSTON AVE SUITE 1
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3931
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Country | US
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Telephone | 973-740-0101
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LEWIS PETER STOLMAN
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Credential | M.D.
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Telephone | 973-740-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 25MA02387300
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License Number State | NJ
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