NPIMap

Organization Active NPI

Dermatology Services, SC

  • Dermatology Physician
  • Wauwatosa, WI
National Provider Identifier
1295783496
Registry record updated Jun 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY SERVICES, SC
Practice address
3077 N Mayfair Rd
Suite 305
Wauwatosa, WI 53222-4305
Phone
(414) 258-3500
Fax
(414) 258-3501
NPI assigned
May 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2012

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

Authorized official

Name
Sidney Herszenson, MDNPI 1841264074
Title
Owner
Phone
(414) 258-3500

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 18537 WI
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

3077 N Mayfair Rd
Suite 305
Wauwatosa, WI 53222-4305

Mailing address

3077 N Mayfair Rd
Suite 305
Wauwatosa, WI 53222-4305
Phone (414) 258-3500

Other identifiers 2

IdentifierTypeStateIssuer
21303900MedicaidWI
CS0892OtherRR MEDICARE

National Provider Directory

National Provider Directory

Locations

3077 N Mayfair Rd
Ste 305
Wauwatosa, WI 53222
Phone (414) 258-3500

Practitioners & affiliated clinicians

Practitioners 1

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": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338768000000",
    "number": "1295783496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3077 N MAYFAIR RD",
            "address_2": "SUITE 305",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532224305",
            "telephone_number": "414-258-3500",
            "fax_number": "414-258-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3077 N MAYFAIR RD",
            "address_2": "SUITE 305",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532224305",
            "telephone_number": "414-258-3500",
            "fax_number": "414-258-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY SERVICES, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2012-06-04",
        "status": "A",
        "authorized_official_last_name": "HERSZENSON",
        "authorized_official_first_name": "SIDNEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-258-3500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "WI",
            "license": "18537",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21303900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CS0892",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.