Individual
MR. MICHAEL COSULICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3350 HIGHWAY 138 WEST, BUILDING 2, SUITE 122, WALL, NJ 07719
(732) 280-1200
(732) 280-1207
Mailing address
3350 HIGHWAY 138 WEST, BUILDING 2, SUITE 122, WALL, NJ 07719
(732) 280-1200
(732) 280-1207
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
24922
MS
207N00000X
Dermatology Physician
Primary
25MA09959400
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2014
Last updated
08/28/2020
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