NPIMap

Organization Active NPI

Vanguard Dermatology

  • Specialist
  • Forest Hills, NY
National Provider Identifier
1336337955
Registry record updated Oct 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
VANGUARD DERMATOLOGY
Practice address
11045 Queens Blvd
Unit 116
Forest Hills, NY 11375-5501
Phone
(718) 332-2999
NPI assigned
Oct 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2007

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

Authorized official

Name
Dr. Michael Shapiro, MD
Title
President
Phone
(718) 332-2999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

11045 Queens Blvd
Unit 116
Forest Hills, NY 11375-5501

Mailing address

14568 3Rd Ave
Whitestone, NY 11357-1101
Phone (718) 332-2999

Other identifiers 1

IdentifierTypeStateIssuer
02692937MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Vanguard Dermatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11045 Queens Blvd
Ste 116
Forest Hills, NY 11375
Phone (718) 332-2999

Practitioners & affiliated clinicians

Practitioners 8

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": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1336337955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14568 3RD AVE",
            "city": "WHITESTONE",
            "state": "NY",
            "postal_code": "113571101",
            "telephone_number": "718-332-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11045 QUEENS BLVD",
            "address_2": "UNIT 116",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113755501",
            "telephone_number": "718-332-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANGUARD DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-332-2999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02692937",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.