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General NPI Number Information
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NPI Number | 1811129141
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND SKIN SURGERY CENTER, PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 10/12/2009
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Provider Practice Location Address
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Address Line | 220 RIDGEDALE AVE SUITE A3
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1348
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Country | US
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Telephone | 973-301-9500
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Fax | 973-301-0435
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Provider Business Mailing Address
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Address Line | 220 RIDGEDALE AVE SUITE A3
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1348
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Country | US
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Telephone | 973-301-9500
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Fax | 973-301-0435
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID ADAM KIKEN
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Credential | M.D.
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Telephone | 973-301-9500
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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 | A89501
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 233992-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 25MA0837050
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License Number State | NJ
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