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General NPI Number Information
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NPI Number | 1659765311
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Entity Type | Organization
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Legal Business Name | COSMEDICAL DERMATOLOGY PA
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 351 EVELYN ST
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City | PARAMUS
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State | NJ
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Zip | 07652-2901
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Country | US
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Telephone | 201-265-1300
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Fax | 201-265-3737
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Provider Business Mailing Address
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Address Line | 351 EVELYN ST
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City | PARAMUS
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State | NJ
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Zip | 07652-2901
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Country | US
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Telephone | 201-265-1300
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Fax | 201-265-3737
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Authorized Official
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Title or Position | DERMATOLOGY COORDINATOR
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Name | MRS. MICHELLE L CAUWENBERGHS
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Credential |
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Telephone | 201-265-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA06657800
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License Number State | NJ
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