Advanced Dermatology Surgery Center

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

25MA06217900 Issued in NJ

Legal business name

ADVANCED DERMATOLOGY SURGERY CENTER

Practice address

4 Hartford Dr
Suite 3
Tinton Falls, NJ 07701-4929

Phone

(732) 933-8500

Fax

(732) 933-4177

NPI assigned

Oct 4, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Glenn Kolansky, MDNPI 1740351683

Title

Owner

Phone

(732) 933-8500

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 1

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

• Glenn Kolansky, M.D.

  • Dermatology Physician
  • Tinton Falls, NJ
  • NPI 1740351683
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1144657164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 HARTFORD DR",
            "address_2": "SUITE 3",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014929",
            "telephone_number": "732-933-8500",
            "fax_number": "732-933-4177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 HARTFORD DR",
            "address_2": "SUITE 3",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014929",
            "telephone_number": "732-933-8500",
            "fax_number": "732-933-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-04",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "KOLANSKY",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-933-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NJ",
            "license": "25MA06217900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Procedural Dermatology Physician in Tinton Falls, NJ
• Providers in Tinton Falls, NJ by specialty
• Procedural Dermatology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; 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.