Elite Dermatology Physicians PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ELITE DERMATOLOGY PHYSICIANS PLLC

Practice address

38 East Ave
New Canaan, CT 06840-5516

Phone

(415) 802-1310

NPI assigned

Jul 25, 2024

Organization subpart

No

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

Authorized official

Name

Ellen De Moll, MDNPI 1518349877

Title

Owner

Phone

(203) 200-0523

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ellen De Moll, MD

  • Dermatology Physician
  • New Canaan, CT
  • NPI 1518349877
  Medicare reassignment Care Compare group NPD Authorized official
• Madison Leigh Ricks, PA-C

  • Physician Assistant
  • Bridgeport, CT
  • NPI 1770256752
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1003644402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 EAST AVE",
            "city": "NEW CANAAN",
            "state": "CT",
            "postal_code": "068405516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 EAST AVE",
            "city": "NEW CANAAN",
            "state": "CT",
            "postal_code": "068405516",
            "telephone_number": "415-802-1310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DERMATOLOGY PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "DE MOLL",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-200-0523",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jane M Ellwanger
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• Dermatology Physician in New Canaan, CT
• Providers in New Canaan, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.