Provider Demographics
NPI:1669747432
Name:CHOICE DERMATOLOGY LLC
Entity type:Organization
Organization Name:CHOICE DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEULENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:908-285-3301
Mailing Address - Street 1:768 SPRINGFIELD AVE
Mailing Address - Street 2:APT. E7
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2340
Mailing Address - Country:US
Mailing Address - Phone:908-285-3301
Mailing Address - Fax:
Practice Address - Street 1:12 RIDGE ST
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1785
Practice Address - Country:US
Practice Address - Phone:908-285-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09007000261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0400465583OtherNJ BUSINESS IDENTIFICATION NUMBER