Dermatology Center of Stamford, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

DERMATOLOGY CENTER OF STAMFORD, LLC

Practice address

1290 Summer St
Suite 3600
Stamford, CT 06905-5360

Phone

(203) 325-3576

Fax

(203) 325-4280

NPI assigned

Aug 15, 2005

Last updated

Mar 13, 2015By 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

Debra Pruzan-Clain, M.D.

Title

Physician/President

Phone

(203) 325-3576

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Rebecca Ross Hall, M.D., C.M.

  • Dermatology Physician
  • Stamford, CT
  • NPI 1992970354
  Medicare reassignment Care Compare group NPD
• Elizabeth Regina Marsh, M.D.

  • Dermatology Physician
  • Scarsdale, NY
  • NPI 1902822794

  CT

  Medicare reassignment Care Compare group NPD
• Severine Marie Chavel, M.D.

  • Dermatology Physician
  • Stamford, CT
  • NPI 1700068103
  Medicare reassignment Care Compare group
• Debra L Pruzan, M.D.

  • Specialist
  • Stamford, CT
  • NPI 1679575112
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426204800000",
    "number": "1356343883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SUMMER ST",
            "address_2": "SUITE 3600",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055360",
            "telephone_number": "203-325-3576",
            "fax_number": "203-325-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 SUMMER ST",
            "address_2": "SUITE 3600",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055360",
            "telephone_number": "203-325-3576",
            "fax_number": "203-325-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER OF STAMFORD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2015-03-13",
        "status": "A",
        "authorized_official_last_name": "PRUZAN-CLAIN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "PHYSICIAN/PRESIDENT",
        "authorized_official_telephone_number": "203-325-3576",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CF8653",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dental Care Kids
• Dental Care of Stamford
• Dental Care Orthodontist
• Dental Group of Stamford
• Dental Permanente of Stamford
• Ketaki Desai, APRN
• Shilpa Desai, PA
• Uday Kumar Desai, M.D.
• Shannon S Desimone, APRN
• Mariana Desku, PHARM-D

• Specialist in Stamford, CT
• Providers in Stamford, CT by specialty
• Specialist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2015; 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.