NPIMap

Organization Active NPI

Island Dermatology, PC

  • Dermatology Physician
  • Long Beach, NY
National Provider Identifier
1316996937
Registry record updated Jul 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ISLAND DERMATOLOGY, PC
Practice address
604 E Park Ave
Long Beach, NY 11561-2505
Phone
(516) 432-0011
Fax
(516) 432-1686
NPI assigned
May 9, 2006
Last updated
Jul 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2011

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

Authorized official

Name
Dr. Ronald Harlan Falcon, MDNPI 1801853965
Title
President
Phone
(516) 432-0011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Dermatopathology Physician 207ND0900X NU

Addresses

Primary practice location

604 E Park Ave
Long Beach, NY 11561-2505

Mailing address

604 E Park Ave
Long Beach, NY 11561-2505
Phone (516) 432-0011

Other identifiers 6

IdentifierTypeStateIssuer
373723OtherAMERIHEALTH
W23131OtherBLUE CROSS/BLUE SHIELD
14478OtherAETNA,USHEALTHCARE
7374OtherVYTRA
01453341MedicaidNY
2200149OtherGHI

National Provider Directory

National Provider Directory

Locations

358 Merrick Rd
Amityville, NY 11701
Phone (631) 598-5373

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309824000000",
    "number": "1316996937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 E PARK AVE",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115612505",
            "telephone_number": "516-432-0011",
            "fax_number": "516-432-1686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 E PARK AVE",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115612505",
            "telephone_number": "516-432-0011",
            "fax_number": "516-432-1686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2011-07-05",
        "status": "A",
        "authorized_official_last_name": "FALCON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "HARLAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-432-0011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "373723",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "W23131",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA,USHEALTHCARE",
            "identifier": "14478",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "7374",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01453341",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2200149",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; 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.