Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25MA02387300 | NJ |
N | 207NS0135X | Procedural Dermatology | 25 MA02387300 | NJ |
NPI | 1396749321 |
---|---|
Provider Name | Dr. Lewis Peter Stolman |
First Address | West Orange, NJ 07052-2744 |
Second Address | West Orange, NJ 07052-2744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 27/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52753 | (02) |