NPIMap

Organization Active NPI

Adult & Pediatric Dermatology Specialists, P.C.

  • Dermatology Physician
  • Trumbull, CT
National Provider Identifier
1013035138
Registry record updated Sep 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 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
Last updated
Sep 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2008

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

Authorized official

Name
Cindy Peterson
Title
Practicing Administrator
Phone
(203) 377-0639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081212000117 CT Part B Supplier - Clinic/Group Practice 5395806095 Receives reassigned benefits from 12 practitioners
Practice locations: Derby, CT; Trumbull, CT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0883635Adult & Pediatric Dermatology Specialists, PC160 Hawley Lane, Trumbull, CT 06611ComplianceOct 17, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1013035138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 HAWLEY LN",
            "address_2": "SUITE 104",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066115300",
            "telephone_number": "203-377-0639",
            "fax_number": "203-386-9706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 HAWLEY LN",
            "address_2": "SUITE 104",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066115300",
            "telephone_number": "203-377-0639",
            "fax_number": "203-386-9706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADULT & PEDIATRIC DERMATOLOGY SPECIALISTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "PRACTICING ADMINISTRATOR",
        "authorized_official_telephone_number": "203-377-0639"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumbull, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; 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.