NPIMap

Organization Active NPI

Empire Dermatology PLLC

  • MOHS-Micrographic Surgery Physician
  • East Syracuse, NY
National Provider Identifier
1336698406
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
282257 Issued in NY
Legal business name
EMPIRE DERMATOLOGY PLLC
Practice address
5823 Widewaters Pkwy
Suite 4
East Syracuse, NY 13057-3084
Phone
(315) 500-7546
Fax
(888) 454-8316
NPI assigned
Sep 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Ms. Patricia H Madden
Title
Practice Manager
Phone
(315) 935-9247

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X 282257 NY Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X

Addresses

Primary practice location

5823 Widewaters Pkwy
Suite 4
East Syracuse, NY 13057-3084

Mailing address

5823 Widewaters Pkwy
Suite 4
East Syracuse, NY 13057-3084
Phone (315) 500-7546

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161024000205 NY Part B Supplier - Clinic/Group Practice 9234417452 Receives reassigned benefits from 16 practitioners
Practice locations: Camillus, NY; East Syracuse, NY; Fulton, NY; North Tonawanda, NY; Oneida, 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
33D2117332Empire Dermatology PLLC5823 Widewaters Parkway, Suite 10, E Syracuse, NY 13057ComplianceMar 6, 2027

National Provider Directory

National Provider Directory

Locations

5301 W Genesee St
Ste 225
Camillus, NY 13031
Phone (315) 500-7546

5823 Widewaters Pkwy
Ste 4
East Syracuse, NY 13057
Phone (315) 278-5049

522 S 4th St
Ste 1300
Fulton, NY 13069
Phone (315) 500-7546

605 Division St
Ste 1
North Tonawanda, NY 14120
Phone (716) 500-7546

301 Genesee St
Ste F
Oneida, NY 13421
Phone (315) 500-7546

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1336698406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5823 WIDEWATERS PKWY",
            "address_2": "SUITE 4",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573084",
            "telephone_number": "315-500-7546",
            "fax_number": "315-378-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5823 WIDEWATERS PKWY",
            "address_2": "SUITE 4",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573084",
            "telephone_number": "315-500-7546",
            "fax_number": "888-454-8316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPIRE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-29",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "MADDEN",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "315-935-9247",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "282257",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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.