Penrose Dermatology PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

245597-1 Issued in NY

Legal business name

PENROSE DERMATOLOGY PLLC

Practice address

1110 South Ave
Suite 400
Staten Island, NY 10314-3403

Phone

(917) 830-1415

Fax

(917) 830-1418

NPI assigned

Mar 17, 2016

Last updated

Jun 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Carolin Penrose, MDNPI 1790946655

Title

Dermatologist

Phone

(917) 620-4421

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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.

• Carolin T Penrose, M.D.

  • Dermatology Physician
  • Staten Island, NY
  • NPI 1790946655
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1346601333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 SOUTH AVE",
            "address_2": "SUITE 400",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143403",
            "telephone_number": "917-830-1415",
            "fax_number": "917-830-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 SOUTH AVE",
            "address_2": "SUITE 400",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143403",
            "telephone_number": "917-830-1415",
            "fax_number": "917-830-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENROSE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "PENROSE",
        "authorized_official_first_name": "CAROLIN",
        "authorized_official_title_or_position": "DERMATOLOGIST",
        "authorized_official_telephone_number": "917-620-4421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NY",
            "license": "245597-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Penfel Health Medical PC
• Valerie Pennacchio, RN
• Louise Pennington
• Viviene Pennington, LMSW
• Mya Pauline Pennisi, MS, OTR/L
• Carolin T Penrose, M.D.
• Mary Pensabene, RPH
• Rosa Pensabene
• Tetyana Pensabene
• People's Choice Pharmacy Ny Corp

• Medical Specialty Clinic/Center in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Medical Specialty Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; 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.