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Organization

COSULICH DERMATOLOGY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MICHAEL COSULICH M.D. (OWNER)
(732) 280-1200
Entity
Organization

Contact information

Practice address
3350 HIGHWAY 138, BUILDING 2 SUITE 122, WALL TOWNSHIP, NJ 07719-9693
(732) 280-1200
(732) 280-1207
Mailing address
3350 HIGHWAY 138, BUILDING 2 SUITE 122, WALL TOWNSHIP, NJ 07719-9693
(732) 280-1200
(732) 280-1207

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
25MA04679500
NJ
207ND0101X
MOHS-Micrographic Surgery Physician
25MA04679500
NJ

Other

Enumeration date
10/19/2011
Last updated
06/07/2021
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