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General NPI Number Information
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NPI Number | 1669747432
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Entity Type | Organization
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Legal Business Name | CHOICE DERMATOLOGY LLC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 12 RIDGE ST
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-1785
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Country | US
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Telephone | 908-285-3301
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Fax |
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Provider Business Mailing Address
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Address Line | 768 SPRINGFIELD AVE APT. E7
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City | SUMMIT
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State | NJ
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Zip | 07901-2340
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Country | US
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Telephone | 908-285-3301
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. MARC C MEULENER
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Credential | MD, PHD
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Telephone | 908-285-3301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA09007000
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License Number State | NJ
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