Laser Skin Therapies at Notchview-Pine Brook, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

25MA05503100 Issued in NJ

Legal business name

LASER SKIN THERAPIES AT NOTCHVIEW-PINE BROOK, LLC

Practice address

1033 US Highway 46
Clifton, NJ 07013-2473

Phone

(973) 779-3911

Fax

(973) 471-2730

NPI assigned

Jun 16, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan Mediterraneo, MD

Title

Member

Phone

(973) 227-0169

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1588824262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 HOOK MOUNTAIN RD",
            "city": "PINE BROOK",
            "state": "NJ",
            "postal_code": "070589798",
            "telephone_number": "973-227-0169",
            "fax_number": "973-227-8942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 US HIGHWAY 46",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070132473",
            "telephone_number": "973-779-3911",
            "fax_number": "973-471-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASER SKIN THERAPIES AT NOTCHVIEW-PINE BROOK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "MEDITERRANEO",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "973-227-0169",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NJ",
            "license": "25MA05503100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Fred Lakin, MD
• Judith Lang-Knutsen, AU.D
• Erica Alesandra Langford, RDN
• Thea Marrie Lapid, PT
• Kristen M Lara, MA, LAC
• Waleed S Lashin, MD
• Lawrence Laspada
• Felipe Lau, LPC
• Diana L Laudati, COTA
• Mark Laureano

• Medical Specialty Clinic/Center in Clifton, NJ
• Providers in Clifton, NJ by specialty
• Medical Specialty Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.