Id of Quincy LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ID OF QUINCY LLC

Practice address

104 Quarry St Ste 2
Quincy, MA 02169-4174

Phone

(617) 472-6764

Fax

(617) 770-9933

NPI assigned

Aug 25, 2021

Last updated

Jan 27, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer T Haley, MD

Title

Authorized Group Official

Phone

(561) 314-2000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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 7

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.

• Kristina Marie Anderson, F.N.P.-C

  • Family Nurse Practitioner
  • Quincy, MA
  • NPI 1003299090
  Medicare reassignment Care Compare group
• Jessica Lee Bahros, PAC

  • Physician Assistant
  • Quincy, MA
  • NPI 1992806772
  Medicare reassignment Care Compare group
• Christina Marie Correnti, MD, MSCR

  • Dermatology Physician
  • Quincy, MA
  • NPI 1225457880
  Medicare reassignment Care Compare group
• Rebeca Jinga, PA-C

  • Physician Assistant
  • Quincy, MA
  • NPI 1760908677
  Medicare reassignment Care Compare group
• David Howard Peckham, PA-C

  • Physician Assistant
  • Quincy, MA
  • NPI 1548411796
  Medicare reassignment Care Compare group
• Kenneth M Reed, M.D.

  • Dermatology Physician
  • Quincy, MA
  • NPI 1295775732
  Medicare reassignment Care Compare group
• Robert W Benson, M.D.

  • Dermatology Physician
  • Ponchatoula, LA
  • NPI 1962406843
  NPD (past)

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769472000000",
    "number": "1053088377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-948-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 QUARRY ST STE 2",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021694174",
            "telephone_number": "617-472-6764",
            "fax_number": "617-770-9933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 Industrial Park Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "MA",
            "postal_code": "023604884",
            "country_code": "US",
            "telephone_number": "617-472-6764",
            "fax_number": "617-770-9933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ID OF QUINCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED GROUP OFFICIAL",
        "authorized_official_telephone_number": "561-314-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Hyde
• Richard W Hynes Jr., LICSW
• Ermal Hysko Sr.
• Faisal Ibrahim, RPH
• Id of Massachusetts LLC
• Kristen Ihde, PSY.D.
• IHS of Massachusetts LLC (Quincy Center Dialysis)
• IHS of Massachusetts LLC (Advance Directions Renal Care Center)
• Illusions of Samsara
• Iman Home Healthcare LLC

• Dermatology Physician in Quincy, MA
• Providers in Quincy, MA by specialty
• Dermatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2026; 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.