| Diare Dermatology Llc | |
|
45 South Ave W Cranford NJ 07016 | |
| (908) 420-1361 | |
| Not Available |
| Full Name | Diare Dermatology Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 45 South Ave W, Cranford, New Jersey |
| Authorized Official Name and Position | Michelle Itidiare (OWNER) |
| Authorized Official Contact | 9084201361 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diare Dermatology Llc 45 South Ave W Ste 102 Cranford NJ 07016-2686 Ph: (908) 420-1361 | Diare Dermatology Llc 45 South Ave W Cranford NJ 07016 Ph: (908) 420-1361 |
| NPI Number | 1366931032 |
|---|---|
| Provider Enumeration Date | 05/08/2018 |
| Last Update Date | 05/18/2018 |
| Medicare PECOS PAC ID | 4284989278 |
|---|---|
| Medicare Enrollment ID | O20180614002407 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366931032 | NPI | - | NPPES |
| 26NJ00625200 | Other | NJ | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 26NJ00625200 (New Jersey) | Primary |
| Provider Name | Michelle Itidiare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194180349 PECOS PAC ID: 4385933399 Enrollment ID: I20160516000032 |
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