Organization Active NPI

Latham Dermatology, PLLC

  • Dermatology Physician
  • Latham, NY
National Provider Identifier
1235616962
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LATHAM DERMATOLOGY, PLLC
Practice address
711 Troy Schenectady Rd Ste 211
Latham, NY 12110-2461
Phone
(518) 783-8780
NPI assigned
Jul 25, 2018
Last updated
Oct 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

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

Authorized official

Name
Adam Plotkin
Title
Authorized Group Official
Phone
(561) 314-2000

Specialties & licenses 1

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

Addresses

Primary practice location

711 Troy Schenectady Rd Ste 211
Latham, NY 12110-2461

Mailing address

4700 Exchange CT Ste 110
Boca Raton, FL 33431-4450
Phone (561) 314-2000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180925002320 NY Part B Supplier - Clinic/Group Practice 5991056228 Receives reassigned benefits from 7 practitioners
Practice locations: Glens Falls, NY; Latham, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2323893Latham Dermatology PLLC711 Troy Schenectady Suite 208, Latham, NY 12110RegistrationMay 14, 2027

National Provider Directory

National Provider Directory

Locations

90 South St
Ste A
Glens Falls, NY 12801
Phone (518) 783-8780

560 Northern Blvd
Ste 202
Great Neck, NY 11021
Phone (516) 773-6660

711 Troy Schenectady Rd
Ste 208
Latham, NY 12110
Phone (518) 783-8780

711 Troy Schenectady Rd
Ste 211
Latham, NY 12110
Phone (213) 200-7708

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538611200000",
    "number": "1235616962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-314-2000",
            "fax_number": "561-431-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 211",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-783-8780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LATHAM DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-10-04",
        "status": "A",
        "authorized_official_last_name": "PLOTKIN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "AUTHORIZED GROUP OFFICIAL",
        "authorized_official_telephone_number": "561-314-2000"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; 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.