Active NPI 1124439757 Individual Practitioner Male Practitioner

Dr. Michael Cosulich , MD

Dermatology • Wall, NJ

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Michael Cosulich, MD is a certified Dermatology practicing in Wall, NJ. With approximately 13 years of clinical experience since graduating from Georgetown University School Of Medicine in 2013, Dr. Cosulich delivers high-quality medical care to the local community at 3350 HIGHWAY 138 WEST.

Dr. Cosulich is affiliated with Cosulich Dermatology Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include aminolevulinic acid hcl for topical administration, 10% gel, 10 mg, injection, tildrakizumab, 1 mg, destruction of precancer skin growth, 2-14 growths. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

3350 Highway 138 West
Building 2, Suite 122

Wall, NJ 07719

Telephone 7322801200

Fax 7322801207

Associated Practice Facility / Clinic

🏢 Cosulich Dermatology Llc Facility NPI 1427333632

Medicare Profile & Education

Medical School

Georgetown University School Of Medicine

Graduation Year

2013

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Wall, NJ

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

13 Yrs +1.5 yrs vs City Avg

City Avg: 11.5 Yrs

State Avg: 27.2 Yrs

Regional Practice Density

3 Specialists

Practicing in Wall, NJ (444 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

55.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Cosulich (13 Years) 13 Yrs

Wall Specialty Average (11.5 Years) 11.5 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	5,600	26	$3.42	$1.68
J3245 Injection, tildrakizumab, 1 mg	4,500	13	$275.23	$135.24
17003 Destruction of precancer skin growth, 2-14 growths	3,681	588	$14.51	$7.33
99213 Established patient office or other outpatient visit, typically 15 minutes	1,897	1,181	$194.55	$98.69
17000 Destruction of skin growth	1,226	796	$146.97	$60.47
11102 Tangential biopsy of single skin lesion	780	637	$218.71	$108.46
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	201	201	$238.58	$121.31
11103 Biopsy of related skin growth, each additional growth	201	146	$109.16	$55.66
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	176	162	$121.66	$61.94
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	159	148	$658.82	$327.62
17110 Destruction of up to 14 skin growths	128	93	$247.96	$125.29
17004 Destruction of precancer skin growth, 15 or more growths	97	65	$363.67	$185.31
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	93	86	$530.05	$135.26
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	80	72	$386.96	$189.68
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	68	23	$30.76	$15.66
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	50	50	$602.15	$154.70
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	45	42	$322.95	$140.69
69100 Biopsy of ear	36	35	$207.19	$80.63
96574 Application of light with debridement to destroy precancer skin growth	28	26	$607.50	$309.26
99202 New patient office or other outpatient visit, typically 20 minutes	28	28	$155.35	$78.85
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	24	23	$374.74	$91.65
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	16	16	$856.61	$437.53
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	13	11	$273.58	$140.07
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	11	11	$673.28	$328.30

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	4,400	19	$3.31	$1.63
17003 Destruction of precancer skin growth, 2-14 growths	3,375	506	$14.98	$7.45
99213 Established patient office or other outpatient visit, typically 15 minutes	1,569	994	$195.68	$97.74
17000 Destruction of skin growth	1,041	698	$149.00	$62.17
11102 Tangential biopsy of single skin lesion	663	531	$227.68	$111.06
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	212	212	$242.93	$121.50
11103 Biopsy of related skin growth, each additional growth	188	141	$112.37	$56.40
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	182	155	$123.38	$61.89
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	179	160	$677.71	$338.26
17004 Destruction of precancer skin growth, 15 or more growths	108	75	$376.38	$187.55
17110 Destruction of up to 14 skin growths	95	85	$255.02	$127.21
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	92	87	$543.34	$136.37
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	65	62	$617.60	$155.06
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	50	41	$397.53	$187.72
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	39	37	$382.84	$93.85
69100 Biopsy of ear	38	37	$215.08	$83.83
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	29	26	$330.30	$142.67
99202 New patient office or other outpatient visit, typically 20 minutes	24	24	$156.70	$79.04
96574 Application of light with debridement to destroy precancer skin growth	21	18	$635.32	$318.76
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	21	21	$888.19	$444.57
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	19	17	$276.62	$132.12

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,147	480	$15.50	$7.75
99213 Established patient office or other outpatient visit, typically 15 minutes	1,442	902	$199.44	$99.69
17000 Destruction of skin growth	982	663	$151.88	$62.87
11102 Tangential biopsy of single skin lesion	659	538	$235.24	$114.04
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	225	225	$246.16	$122.58
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	219	180	$125.18	$62.76
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	209	178	$691.58	$342.18
11103 Biopsy of related skin growth, each additional growth	175	133	$116.80	$58.40
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	107	94	$553.84	$139.02
17004 Destruction of precancer skin growth, 15 or more growths	99	67	$383.48	$192.24
17110 Destruction of up to 14 skin growths	89	82	$260.08	$130.53
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	80	72	$627.84	$153.50
99202 New patient office or other outpatient visit, typically 20 minutes	47	47	$161.18	$80.83
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	44	41	$404.68	$191.69
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	38	36	$392.96	$98.66
69100 Biopsy of ear	38	35	$220.48	$87.45
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	33	30	$335.72	$155.90
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	23	22	$280.82	$140.63
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	17	17	$707.96	$345.78
11104 Punch biopsy, first skin growth	15	15	$292.20	$134.85
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	12	12	$606.32	$304.80
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	11	11	$763.30	$366.16
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	11	11	$909.52	$454.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,191	464	$14.88	$7.48
99213 Established patient office or other outpatient visit, typically 15 minutes	1,137	755	$200.32	$100.92
17000 Destruction of skin growth	991	655	$148.71	$59.33
11102 Tangential biopsy of single skin lesion	746	600	$237.62	$117.18
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	404	333	$124.35	$62.47
11103 Biopsy of related skin growth, each additional growth	260	172	$120.21	$60.41
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	209	209	$246.16	$124.43
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	197	170	$700.28	$350.88
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	133	120	$559.50	$141.70
17004 Destruction of precancer skin growth, 15 or more growths	97	73	$374.69	$189.72
17110 Destruction of up to 14 skin growths	81	70	$259.32	$127.32
99202 New patient office or other outpatient visit, typically 20 minutes	69	69	$161.07	$81.26
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	57	50	$403.00	$188.19
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	55	52	$633.18	$160.44
69100 Biopsy of ear	48	47	$224.68	$90.02
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	40	34	$335.91	$148.88
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	29	24	$283.82	$143.49
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	29	28	$393.73	$102.85
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	21	19	$704.62	$322.83
11104 Punch biopsy, first skin growth	17	17	$297.00	$145.96
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	15	14	$576.40	$146.05
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	13	13	$920.38	$466.20
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	13	12	$1524.27	$771.55
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	12	12	$762.34	$386.32

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,509	385	$6.84	$6.87
17000 Destruction of skin growth	820	549	$73.21	$58.17
99213 Established patient office or other outpatient visit, typically 15 minutes	690	491	$82.47	$82.81
11102 Tangential biopsy of single skin lesion	595	478	$114.07	$111.07
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	405	304	$118.89	$119.93
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	192	164	$50.33	$50.58
11103 Biopsy of related skin growth, each additional growth	187	121	$60.58	$60.58
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	186	160	$342.99	$339.31
99202 New patient office or other outpatient visit, typically 20 minutes	183	183	$83.44	$83.41
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	125	108	$280.51	$139.71
17004 Destruction of precancer skin growth, 15 or more growths	78	56	$178.44	$179.12
17110 Destruction of up to 14 skin growths	64	55	$127.92	$124.50
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	56	52	$314.89	$158.55
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	47	47	$117.71	$118.80
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	47	39	$194.80	$178.26
69100 Biopsy of ear	30	27	$112.41	$87.21
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	27	26	$194.19	$96.13
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	20	18	$439.68	$443.44
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	20	20	$743.10	$751.27
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	16	16	$160.61	$151.75
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	16	16	$348.96	$351.63
11104 Punch biopsy, first skin growth	13	12	$142.19	$143.22
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	12	11	$320.45	$272.49

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,475	352	$5.99	$5.83
17000 Destruction of skin growth	794	509	$73.86	$57.91
11102 Tangential biopsy of single skin lesion	562	440	$135.00	$106.75
99213 Established patient office or other outpatient visit, typically 15 minutes	562	403	$79.58	$79.11
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	384	287	$117.13	$116.51
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	237	202	$48.78	$47.88
11103 Biopsy of related skin growth, each additional growth	181	133	$75.00	$59.19
99202 New patient office or other outpatient visit, typically 20 minutes	180	180	$83.17	$82.89
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	110	99	$338.05	$335.50
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	109	95	$279.05	$137.17
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	82	82	$117.43	$116.83
17004 Destruction of precancer skin growth, 15 or more growths	77	55	$160.01	$159.45
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	72	67	$438.31	$435.93
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	71	66	$315.95	$156.25
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	64	60	$478.17	$442.69
17110 Destruction of up to 14 skin growths	61	55	$126.60	$122.12
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	47	45	$186.35	$96.95
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	44	40	$198.56	$189.73
69100 Biopsy of ear	35	32	$112.41	$93.36
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	33	28	$734.66	$708.27
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	29	26	$526.43	$407.93
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	29	26	$161.97	$137.99
11104 Punch biopsy, first skin growth	21	21	$175.00	$138.24
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	12	11	$432.44	$430.81

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,200	320	$6.41	$5.76
17000 Destruction of skin growth	657	430	$74.80	$57.20
99213 Established patient office or other outpatient visit, typically 15 minutes	583	431	$79.73	$78.22
11100 Biopsy of single growth of skin and/or tissue	467	358	$118.18	$109.50
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	266	222	$117.43	$115.27
11101 Biopsy of each additional growth of skin and/or tissue	173	111	$35.96	$35.17
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	136	118	$279.96	$135.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	120	101	$48.45	$47.44
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	111	99	$338.08	$323.99
17004 Destruction of precancer skin growth, 15 or more growths	101	75	$161.15	$157.54
17110 Destruction of up to 14 skin growths	99	92	$127.64	$122.27
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	95	90	$315.37	$154.93
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	86	80	$473.68	$442.95
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	83	77	$437.12	$429.00
99202 New patient office or other outpatient visit, typically 20 minutes	63	63	$81.96	$80.72
69100 Biopsy of ear	39	35	$112.41	$73.74
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	36	36	$117.89	$115.67
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	27	26	$196.29	$184.80
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	24	22	$732.62	$720.91
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	22	21	$134.47	$132.32
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	21	21	$157.78	$155.25
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	21	18	$185.74	$91.38
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	17	16	$146.90	$144.15
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	14	12	$526.43	$370.01
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	11	11	$134.26	$126.30

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	616	123	$6.76	$6.13
17000 Destruction of skin growth	184	167	$74.61	$55.32
11100 Biopsy of single growth of skin and/or tissue	144	136	$115.02	$107.56
99213 Established patient office or other outpatient visit, typically 15 minutes	118	113	$79.38	$78.14
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	98	97	$117.07	$113.98
11101 Biopsy of each additional growth of skin and/or tissue	69	42	$36.10	$35.25
17004 Destruction of precancer skin growth, 15 or more growths	48	40	$166.23	$163.57
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	40	40	$274.98	$142.05
17110 Destruction of up to 14 skin growths	38	36	$123.82	$120.24
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	34	27	$48.11	$46.99
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	31	30	$472.73	$465.17
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	30	30	$313.38	$154.18
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	28	28	$438.88	$431.86
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	27	27	$117.68	$115.52
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	25	25	$336.86	$331.47
99202 New patient office or other outpatient visit, typically 20 minutes	23	23	$81.64	$80.26

Medical Specialties & State Licenses

CMS Verified: 2020-08-28

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License NJ 25MA09959400

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Dermatology

NUCC Taxonomy Code: 207N00000X

State License MS 24922

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Hospital & Practice Group Affiliations

Cosulich Dermatology Llc

3350 Hwy 138 W, Wall, NJ 077199694

Phone: 7322801200

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners

Kimberly Herlihy Rand , NP

Nurse Practitioner - Family

NPI 1093092488

Nurse Practitioner

Dr. William Cosulich , MD

Dermatology

NPI 1427143312

Doctor of Medicine (M.D.)

Kim Morales , PA

Physician Assistant

NPI 1528153814

Physician Assistant

Emily Mcewan

Nurse Practitioner - Family

NPI 1851270722

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

15 Historical Events

📍

Updated Practice Location August 28, 2020

Registered at 3350 HIGHWAY 138 WEST, BUILDING 2, SUITE 122, WALL, NJ 07719 (Tel: 7322801200)

📍

Updated Business Mailing Address August 28, 2020

Registered at 3350 HIGHWAY 138 WEST, BUILDING 2, SUITE 122, WALL, NJ 07719 (Tel: 7322801200)

👤

Provider Name / Credentials Updated August 28, 2020

Recorded as MICHAEL COSULICH, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 28, 2020

Dermatology (License #25MA09959400 in NJ)

✅

NPI Profile Active June 15, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location June 15, 2017

Registered at 2500 N STATE ST, JACKSON, MS 392164500 (Tel: 6018158000)

📍

Updated Business Mailing Address June 15, 2017

Registered at 2500 N STATE ST, JACKSON, MS 392164500 (Tel: 6018153374)

👤

Provider Name / Credentials Updated June 15, 2017

Recorded as MICHAEL COSULICH, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 15, 2017

Dermatology (License #24922 in MS)

✅

NPI Profile Active May 16, 2014

NPI status registered as active in NPPES database

📍

Updated Practice Location May 16, 2014

Registered at 2500 N STATE ST, JACKSON, MS 392164500 (Tel: 6018158000)

📍

Updated Business Mailing Address May 16, 2014

Registered at 2500 N STATE ST, JACKSON, MS 392164500 (Tel: 6018158000)

👤

Provider Name / Credentials Updated May 16, 2014

Recorded as MICHAEL COSULICH, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 16, 2014

Student in an Organized Health Care Education/Training Program

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Initial NPI Registration & Enumeration May 16, 2014

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1124439757

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: May 16, 2014

Last Update: August 28, 2020

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

3350 Highway 138 West, Building 2, Suite 122

Wall, NJ 07719

Phone: 7322801200

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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