NPIMap

Organization Active NPI

Advanced Dermatology of Melrose, PLLC

  • Dermatology Physician
  • Melrose, MA
National Provider Identifier
1013678747
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ADVANCED DERMATOLOGY OF MELROSE, PLLC
Practice address
802 Main St
Melrose, MA 02176-2708
Phone
(978) 371-7010
NPI assigned
Jan 5, 2022
Last updated
Jan 5, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
STEVEN I. KORNBLEUTH, MDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Authorized official

Name
Samuel GoosNPI 1548240039
Title
Owner
Phone
(978) 371-7010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

802 Main St
Melrose, MA 02176-2708

Mailing address

526 Main St Ste 302
Acton, MA 01720-3301
Phone (978) 371-7010

National Provider Directory

National Provider Directory
Part of
Steven Ira Kornbleuth

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1013678747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 MAIN ST STE 302",
            "city": "ACTON",
            "state": "MA",
            "postal_code": "017203301",
            "telephone_number": "978-371-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 MAIN ST",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021762708",
            "telephone_number": "978-371-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF MELROSE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEVEN I. KORNBLEUTH, MD",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "GOOS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-371-7010"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.