NPIMap

Organization Active NPI

Wesson Dermatology, PC

  • Dermatology Physician
  • Great Neck, NY
National Provider Identifier
1346514411
Registry record updated Mar 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
223800 Issued in NY
Legal business name
WESSON DERMATOLOGY, PC
Practice address
1010 Northern Blvd
Suite 120
Great Neck, NY 11021-5317
Phone
(516) 829-0050
Fax
(516) 829-0052
NPI assigned
Mar 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2012

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

Authorized official

Name
Dr. Karen Michelle Wesson, M.D.NPI 1023084696
Title
President
Phone
(516) 829-0050

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 223800 NY Primary

Addresses

Primary practice location

1010 Northern Blvd
Suite 120
Great Neck, NY 11021-5317

Mailing address

1010 Northern Blvd
Suite 120
Great Neck, NY 11021-5317
Phone (516) 829-0050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120924000611 NY Part B Supplier - Clinic/Group Practice 9830347483 Receives reassigned benefits from 6 practitioners
Practice locations: Great Neck, NY

National Provider Directory

National Provider Directory

Locations

1010 Northern Blvd
Ste 120
Great Neck, NY 11021
Phone (516) 829-0050

Practitioners & affiliated clinicians

Practitioners 6

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": "1330992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330992000000",
    "number": "1346514411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 NORTHERN BLVD",
            "address_2": "SUITE 120",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215317",
            "telephone_number": "516-829-0050",
            "fax_number": "516-829-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 NORTHERN BLVD",
            "address_2": "SUITE 120",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215317",
            "telephone_number": "516-829-0050",
            "fax_number": "516-829-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESSON DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-06",
        "last_updated": "2012-03-06",
        "status": "A",
        "authorized_official_last_name": "WESSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-829-0050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "223800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; 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.