Dermatology & Laser Surgery Ctr

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

65361 Issued in NJ

Legal business name

DERMATOLOGY & LASER SURGERY CTR

Practice address

2125 Center Ave
Suite 200
Fort Lee, NJ 07024-5859

Phone

(201) 461-5655

Fax

(201) 461-1181

NPI assigned

Oct 23, 2012

Last updated

Oct 17, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Olga Goulko, M.D.NPI 1710094578

Title

Medical Doctor

Phone

(201) 461-5655

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Olga Goulko, M.D.

  • Dermatology Physician
  • Fort Lee, NJ
  • NPI 1710094578
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1350950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381968000000",
    "number": "1780937045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 CENTER AVE",
            "address_2": "SUITE 200",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070245859",
            "telephone_number": "201-461-5655",
            "fax_number": "201-461-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 CENTER AVE",
            "address_2": "SUITE 200",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070245859",
            "telephone_number": "201-461-5655",
            "fax_number": "201-461-1181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & LASER SURGERY CTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-23",
        "last_updated": "2013-10-17",
        "status": "A",
        "authorized_official_last_name": "GOULKO",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "201-461-5655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "65361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Dermatology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.