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General NPI Number Information
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NPI Number | 1710031919
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Entity Type | Organization
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Legal Business Name | LIGRESTI DERMATOLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 36 NEWARK AVENUE SUITE 120
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City | BELLEVILLE
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State | NJ
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Zip | 07109-4120
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Country | US
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Telephone | 973-759-6569
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Fax | 973-759-2562
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Provider Business Mailing Address
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Address Line | 36 NEWARK AVENUE SUITE 120
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City | BELLEVILLE
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State | NJ
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Zip | 07109-4120
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Country | US
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Telephone | 973-759-6569
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Fax | 973-759-2562
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Authorized Official
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Title or Position | OWNER LIGRESTI DERMATOLOGY ASSOCIAT
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Name | DOMINICK JOSEPH LIGRESTI
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Credential | MD
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Telephone | 973-759-6569
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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 | MA40615
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License Number State | NJ
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