Image Dermatology PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA65931 Issued in NJ

Legal business name

IMAGE DERMATOLOGY PC

Practice address

51 Park St
Montclair, NJ 07042-3439

Phone

(973) 509-6900

Fax

(973) 509-6939

NPI assigned

May 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jeanine B. Downie, M.D.NPI 1811959232

Title

Owner

Phone

(973) 509-6900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Locations

Practitioners 2

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

• Jeanine B. Downie, M. D.

  • Dermatology Physician
  • Montclair, NJ
  • NPI 1811959232
  Medicare reassignment Care Compare group NPD Authorized official
• Megan J Kera, PA-C

  • Physician Assistant
  • Montclair, NJ
  • NPI 1467892752
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201132800000",
    "number": "1104027556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 PARK ST",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423439",
            "telephone_number": "973-509-6900",
            "fax_number": "973-509-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 PARK ST",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423439",
            "telephone_number": "973-509-6900",
            "fax_number": "973-509-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGE DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "DOWNIE",
        "authorized_official_first_name": "JEANINE",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-509-6900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "MA65931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; 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.