NPIMap

Organization Active NPI

Golden Age Dermatology PLLC

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1154871846
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
GOLDEN AGE DERMATOLOGY PLLC
Practice address
345 E 37TH St
301
New York, NY 10016-3256
Phone
(212) 734-6621
NPI assigned
Oct 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

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

Authorized official

Name
Brooke Lichtenstein
Title
Director
Phone
(212) 734-6621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

345 E 37TH St
301
New York, NY 10016-3256

Mailing address

250 Skillman St Ste 202
Brooklyn, NY 11205-1218
Phone (212) 734-6621

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161115002530 NY Part B Supplier - Clinic/Group Practice 3870872880 Receives reassigned benefits from 8 practitioners
Practice locations: Far Rockaway, NY; New York, NY

National Provider Directory

National Provider Directory

Locations

49 Oakcrest Ave
Middle Island, NY 11953
Phone (631) 560-4857

Practitioners & affiliated clinicians

Practitioners 11

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": "1475712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1154871846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 SKILLMAN ST STE 202",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112051218",
            "telephone_number": "212-734-6621",
            "fax_number": "516-430-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 E 37TH ST",
            "address_2": "301",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100163256",
            "telephone_number": "212-734-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN AGE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-06",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "LICHTENSTEIN",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "212-734-6621"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.