NPIMap

Organization Active NPI

Arizona Skin and Laser Therapy Institue, LTD

  • Radiation Oncology Physician
  • Phoenix, AZ
National Provider Identifier
1083066450
Registry record updated Jul 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
ARIZONA SKIN AND LASER THERAPY INSTITUE, LTD
Practice address
16620 N 40TH St
Suite C-3
Phoenix, AZ 85032-3348
Phone
(602) 396-0851
Fax
(602) 841-0611
NPI assigned
Jul 8, 2016
Last updated
Jul 8, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2016

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

Authorized official

Name
Neil P Superfon, D.O.
Title
Physician
Phone
(602) 277-1449

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

16620 N 40TH St
Suite C-3
Phoenix, AZ 85032-3348

Mailing address

2224 W. Northern Ave.
Suite D-300
Phoenix, AZ 85021-5099
Phone (602) 277-1449

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000424 AZ Part B Supplier - Clinic/Group Practice 6204720626 Receives reassigned benefits from 17 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Apache Junction, AZ; Coolidge, AZ; Gilbert, AZ; Mesa, AZ; Phoenix, AZ; Quartzsite, AZ; Scottsdale, AZ; Show Low, AZ

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2285 Corporate Cir
Ste 200
Henderson, NV 89074
Phone (702) 360-2763

NPI Registry JSON

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

{
    "created_epoch": "1467936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467936000000",
    "number": "1083066450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 W. NORTHERN AVE.",
            "address_2": "SUITE D-300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850215099",
            "telephone_number": "602-277-1449",
            "fax_number": "602-277-9984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16620 N 40TH ST",
            "address_2": "SUITE C-3",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323348",
            "telephone_number": "602-396-0851",
            "fax_number": "602-841-0611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA SKIN AND LASER THERAPY INSTITUE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-08",
        "last_updated": "2016-07-08",
        "status": "A",
        "authorized_official_last_name": "SUPERFON",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "602-277-1449",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; 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.