Adult & Pediatric Dermatology Specialists, P.C.
Organization Active NPI Dermatology Physician · Trumbull, CT
NPI 1013035138 · NPPES record last updated Sep 16, 2008
Key facts
- NPI
- 1013035138
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- ADULT & PEDIATRIC DERMATOLOGY SPECIALISTS, P.C.
- Practice address
- 160 Hawley LN
Suite 104
Trumbull, CT 06611-5300 - Phone
- (203) 377-0639
- Fax
- (203) 386-9706
- NPI assigned
- Mar 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Cindy Peterson
- Title
- Practicing Administrator
- Phone
- (203) 377-0639
Other NPIs with the same Medicare PAC ID 1
Practitioners 14
-
Ai-Tram Ngoc Bui, MD
-
Alexander Fogel, MD
-
Tamara Handerson, MD
-
Michael Patrick Noonan, M.D.
-
Jason Matthew Wilder, D.O.
-
Faith Dang-Khoa Huynh, PA-C
-
Andrea Jacobs-Stannard, P.A.
-
Lisa Gavronsky, PA-C
-
Brooke Danielle Hatfield, PA-C
-
Seth Perry Lerner, M.D.
-
Mark Ian Oestreicher, M.D.
-
Payal Shah, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D0883635 | Adult & Pediatric Dermatology Specialists, PC | Compliance | Oct 17, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081212000117 | CT | Part B Supplier - Clinic/Group Practice | 5395806095 |
Receives reassigned benefits from 12 practitioners Practice locations: Derby, CT; Trumbull, CT |
National Provider Directory
Locations
160 Hawley Ln
Ste 104
Trumbull, CT 06611
Phone (203) 377-0639
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
160 Hawley LN
Suite 104
Trumbull, CT 06611-5300
Mailing address
160 Hawley LN
Suite 104
Trumbull, CT 06611-5300
Phone (203) 377-0639
Other providers in Trumbull, CT
- Nada M Abdel a'Al
- Roxanne C Abder
- Bassem Onsy Abraham
- Charlene Adams
- Jenna Addison
- Advanced Natural Therapeutics, LLC
- Aftercare Physical Therapy Services LLC
- Zara Ahmed
- Oluwatobi Taiwo Akangbe
- Alena Al-Bochi Mazie
All providers in Trumbull, CT · Dermatology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.