Provider Demographics
NPI:1487770905
Name:ASSOCIATES IN DERMATOLOGY AND COSMETIC SURGERY THE MILLBURN LASER CENT
Entity type:Organization
Organization Name:ASSOCIATES IN DERMATOLOGY AND COSMETIC SURGERY THE MILLBURN LASER CENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-376-8500
Mailing Address - Street 1:12 EAST WILLOW STREET
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1737
Mailing Address - Country:US
Mailing Address - Phone:973-376-8500
Mailing Address - Fax:973-376-1820
Practice Address - Street 1:12 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1417
Practice Address - Country:US
Practice Address - Phone:973-376-8500
Practice Address - Fax:973-376-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC68842207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
070015262OtherRAILROAD MEDICARE PROVIDER NO.
NJ2299713OtherAETNA GROUP PIN
NJ2299763OtherGHI PROVIDER NO.
NJ0439712000OtherAMERIHEALTH GROUP PROVIDER NO.
NJDA1464OtherRAILROAD MEDICARE GROUP PIN
NJDA1464OtherRAILROAD MEDICARE GROUP PIN