NPIMap

Organization Active NPI

Children's Skin and Laser, PC

Doing business as Brooklyn Dermatology

  • Pediatric Dermatology Physician
  • Brooklyn, NY
National Provider Identifier
1265618532
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Dermatology PhysicianTaxonomy code 207NP0225X
License
226018 Issued in NY
Legal business name
CHILDREN'S SKIN AND LASER, PC
Doing business as
Brooklyn Dermatology
Practice address
440 Atlantic Ave
Ground Floor
Brooklyn, NY 11217-2143
Phone
(718) 797-5504
Fax
(718) 797-5645
NPI assigned
Jan 16, 2008
Last updated
Nov 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

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

Authorized official

Name
Dr. Sourab Patrick Choudhury, DONPI 1861453698
Title
President
Phone
(718) 797-5504

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 226018 NY
Pediatric Dermatology Physician 207NP0225X 226018 NY Primary
Procedural Dermatology Physician 207NS0135X 226018 NY

Addresses

Primary practice location

440 Atlantic Ave
Ground Floor
Brooklyn, NY 11217-2143

Mailing address

440 Atlantic Ave
Ground Floor
Brooklyn, NY 11217-2143
Phone (718) 797-5504

Other names 1

  • Brooklyn Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051207000093 NY Part B Supplier - Clinic/Group Practice 6800816760 Receives reassigned benefits from 4 practitioners
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

440 Atlantic Ave
Fl Ground
Brooklyn, NY 11217
Phone (718) 797-5504

Practitioners & affiliated clinicians

Practitioners 12

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": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1265618532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 ATLANTIC AVE",
            "address_2": "GROUND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112172143",
            "telephone_number": "718-797-5504",
            "fax_number": "718-797-5645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 ATLANTIC AVE",
            "address_2": "GROUND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112172143",
            "telephone_number": "718-797-5504",
            "fax_number": "718-797-5645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S SKIN AND LASER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "CHOUDHURY",
        "authorized_official_first_name": "SOURAB",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-797-5504",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "226018",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "NY",
            "license": "226018",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NY",
            "license": "226018",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brooklyn Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; 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.