Provider Demographics
NPI:1518310366
Name:SKIN & LASER CENTER OF NJ, LLC
Entity Type:Organization
Organization Name:SKIN & LASER CENTER OF NJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-500-7525
Mailing Address - Street 1:500 N FRANKLIN TPKE STE 318
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1160
Mailing Address - Country:US
Mailing Address - Phone:201-500-7525
Mailing Address - Fax:201-500-7527
Practice Address - Street 1:500 N FRANKLIN TPKE STE 318
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1160
Practice Address - Country:US
Practice Address - Phone:201-500-7525
Practice Address - Fax:201-500-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08780100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty