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General NPI Number Information
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NPI Number | 1912374265
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Entity Type | Organization
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Legal Business Name | QUALITY DERMATOLOGY
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 180 TAYLORS MILLS RD
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City | MANALAPAN
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State | NJ
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Zip | 07726-3306
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Country | US
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Telephone | 917-593-1722
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Fax |
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Provider Business Mailing Address
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Address Line | 180 TAYLORS MILLS RD
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City | MANALAPAN
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State | NJ
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Zip | 07726-3306
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Country | US
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Telephone | 917-593-1722
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. RENATA FLAKS
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Credential | DNP
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Telephone | 917-593-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 26NJ00300300
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License Number State | NJ
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