Organization
DIARE DERMATOLOGY LLC
Active
Organization
DIARE DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE ITIDIARE (OWNER)
(908) 420-1361
Entity
Organization
Contact information
Practice address
45 SOUTH AVE W, CRANFORD, NJ 07016
(908) 420-1361
Mailing address
45 SOUTH AVE W STE 102, CRANFORD, NJ 07016-2686
(908) 420-1361
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
26NJ00625200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26NJ00625200
LICENSE
NJ
Enumeration date
05/08/2018
Last updated
05/18/2018
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