Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25MA04679500 | NJ |
N | 207ND0101X | MOHS-Micrographic Surgeon | 25MA04679500 | NJ |
N | 207NS0135X | Procedural Dermatology | 25MA04679500 | NJ |
NPI | 1427143312 |
---|---|
Provider Name | Dr. William F Cosulich |
First Address | Wall, NJ 07719 |
Second Address | Wall, NJ 07719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 22/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C54120 | (02) |