Dermatology Boutique PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME74763 Issued in FL

Legal business name

DERMATOLOGY BOUTIQUE PA

Practice address

110 N Federal Hwy
Ste 302
Hallandale Beach, FL 33009-4300

Phone

(855) 465-6621

Fax

(888) 407-3376

NPI assigned

Aug 18, 2014

Last updated

Feb 25, 2020By 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

Dr. Cynthia Ann Golomb, MDNPI 1619900388

Title

Owner

Phone

(855) 465-6621

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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.

• Cynthia Golomb, MD

  • Dermatology Physician
  • Hallandale Beach, FL
  • NPI 1619900388
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1408320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1104225887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N FEDERAL HWY STE 202",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330094373",
            "telephone_number": "855-465-6621",
            "fax_number": "888-407-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N FEDERAL HWY",
            "address_2": "STE 302",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330094300",
            "telephone_number": "855-465-6621",
            "fax_number": "888-407-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY BOUTIQUE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-18",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "GOLOMB",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-465-6621",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME74763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Group of Florida PA
• Jonias Destine, PA-C
• Amanda Diab El Harakeh
• Diagnostic Associates of Florida, Inc.
• Ismael Diaw

• Dermatology Physician in Hallandale Beach, FL
• Providers in Hallandale Beach, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.