Provider Demographics
NPI:1174637722
Name:KUFLIK DERMATOLOGY, P. A.
Entity Type:Organization
Organization Name:KUFLIK DERMATOLOGY, P. A.
Other - Org Name:EMANUEL G. KUFLIK, MD, P. A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUFLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-341-0515
Mailing Address - Street 1:453 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6342
Mailing Address - Country:US
Mailing Address - Phone:732-341-0515
Mailing Address - Fax:732-240-0933
Practice Address - Street 1:453 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6342
Practice Address - Country:US
Practice Address - Phone:732-341-0515
Practice Address - Fax:732-240-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty