Organization
DERMATOLOGY & LASER SURGERY CTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLGA GOULKO M.D. (MEDICAL DOCTOR)
(201) 461-5655
Entity
Organization
Contact information
Practice address
2125 CENTER AVE, SUITE 200, FORT LEE, NJ 07024-5859
(201) 461-5655
(201) 461-1181
Mailing address
2125 CENTER AVE, SUITE 200, FORT LEE, NJ 07024-5859
(201) 461-5655
(201) 461-1181
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
65361
NJ
Other
Enumeration date
10/23/2012
Last updated
10/17/2013
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