| NPI | 1427333632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL COSULICH Owner 732-280-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA04679500) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA04679500) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2021-06-07 |