Advanced Dermatology & Laser Center, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

035123 Issued in CT

Legal business name

ADVANCED DERMATOLOGY & LASER CENTER, LLC

Doing business as

Westport Dermatology

Practice address

489 Post Road East
Westport, CT 06880

Phone

(203) 226-3600

Fax

(203) 226-2555

NPI assigned

Jul 23, 2006

Last updated

Feb 6, 2013By 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

Tanya Futoryan, MDNPI 1063438463

Title

Medical Director

Phone

(203) 226-3600

Specialties & licenses 1

Addresses

Other names 1

• Westport Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 5

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.

• Tanya S Futoryan, MD

  • Dermatology Physician
  • Westport, CT
  • NPI 1063438463
  Medicare reassignment Care Compare group NPD Authorized official
• Samuel Gettler, MD

  • Dermatology Physician
  • Stamford, CT
  • NPI 1841221264
  Medicare reassignment Care Compare group
• Lauren Lee Levy

  • Dermatology Physician
  • Westport, CT
  • NPI 1720320435
  Medicare reassignment Care Compare group
• Ellen Matteson, PA-C

  • Medical Physician Assistant
  • Westport, CT
  • NPI 1427320282
  NPD (past)
• Taylor Nicole Oliva, RN

  • Registered Nurse
  • Westport, CT
  • NPI 1588571327
  NPD (past)

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360108800000",
    "number": "1063433969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "489 POST ROAD EAST",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "06880",
            "telephone_number": "203-226-3600",
            "fax_number": "203-226-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 POST ROAD EAST",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "06880",
            "telephone_number": "203-226-3600",
            "fax_number": "203-226-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY & LASER CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2013-02-06",
        "status": "A",
        "authorized_official_last_name": "FUTORYAN",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "203-226-3600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "035123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westport Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abby Adis, MSW
• Adult & Pediatric Dermatology Specialists, P.C.
• Adult and Pediatric Dental Care of Westport,LLC
• Advanced Concussion Solutions LLC
• Advanced Dental of Westport (Westport Fairfield Dental)
• Advanced TMS Health Centers Inc.
• Aesthetic Plastic Surgery Center LLC
• Mark Agnew
• Hannah Ahn, D.D.S.
• Akurra LLC (Bodywork Docs)

• Dermatology Physician in Westport, CT
• Providers in Westport, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.