NPIMap

Organization Active NPI

Enfield Dermatology LLC

  • Procedural Dermatology Physician
  • Enfield, CT
National Provider Identifier
1073705232
Registry record updated Oct 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
038326 Issued in CT
Legal business name
ENFIELD DERMATOLOGY LLC
Practice address
146 Hazard Ave
Suite 101
Enfield, CT 06082-4571
Phone
(860) 749-7437
Fax
(860) 749-0493
NPI assigned
Aug 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2007

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

Authorized official

Name
Mrs. Elizabeth A Sheehan
Title
Office Manger
Phone
(860) 749-7437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NS0135X 038326 CT Primary

Addresses

Primary practice location

146 Hazard Ave
Suite 101
Enfield, CT 06082-4571

Mailing address

146 Hazard Ave
Suite 101
Enfield, CT 06082-4571
Phone (860) 749-7437

National Provider Directory

National Provider Directory

Locations

146 Hazard Ave
Ste 101A
Enfield, CT 06082
Phone (860) 749-7437

146 Hazard Ave
Ste 101
Enfield, CT 06082
Phone (860) 749-7437

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192147200000",
    "number": "1073705232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 HAZARD AVE",
            "address_2": "SUITE 101",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824571",
            "telephone_number": "860-749-7437",
            "fax_number": "860-749-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 HAZARD AVE",
            "address_2": "SUITE 101",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824571",
            "telephone_number": "860-749-7437",
            "fax_number": "860-749-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENFIELD DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2007-10-12",
        "status": "A",
        "authorized_official_last_name": "SHEEHAN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANGER",
        "authorized_official_telephone_number": "860-749-7437",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CT",
            "license": "038326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; 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.