Organization
ORTHIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ETHAN SKOLNICK (OWNER)
(973) 472-4900
Entity
Organization
Contact information
Practice address
1124 E JERSEY ST, ELIZABETH, NJ 07201-2406
(973) 472-4900
Mailing address
1124 E JERSEY ST, ELIZABETH, NJ 07201-2406
(973) 472-4900
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0302066
—
NJ
Enumeration date
10/24/2018
Last updated
10/24/2018
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