NPIMap

Organization Active NPI

Rockville Dermatology, PC

  • Dermatology Physician
  • Rockville Centre, NY
National Provider Identifier
1356349153
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
197033 Issued in NY
Legal business name
ROCKVILLE DERMATOLOGY, PC
Practice address
2000 N Village Ave
Suite 203
Rockville Centre, NY 11570-1078
Phone
(516) 763-1717
Fax
(516) 678-4996
NPI assigned
Jul 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Authorized official

Name
Dr. Stuart R Levine, D.O.NPI 1386622579
Title
President
Phone
(516) 763-1717

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 197033 NY Primary

Addresses

Primary practice location

2000 N Village Ave
Suite 203
Rockville Centre, NY 11570-1078

Mailing address

2000 N Village Ave
Suite 203
Rockville Centre, NY 11570-1078
Phone (516) 763-1717

Other identifiers 1

IdentifierTypeStateIssuer
7673541OtherAETNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040325001274 NY Part B Supplier - Clinic/Group Practice 1456243476 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
Practice locations: Rockville Centre, NY; Smithtown, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
33D1031126Rockville Dermatology PC2000 North Village Avenue, Suite #203, Rockville Centre, NY 11570ComplianceMay 5, 2027

National Provider Directory

National Provider Directory

Locations

2000 N Village Ave
Ste 203
Rockville Ctr, NY 11570
Phone (516) 763-1717

2000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1777

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1356349153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 N VILLAGE AVE",
            "address_2": "SUITE 203",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115701078",
            "telephone_number": "516-763-1717",
            "fax_number": "516-678-4996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N VILLAGE AVE",
            "address_2": "SUITE 203",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115701078",
            "telephone_number": "516-763-1717",
            "fax_number": "516-678-4996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKVILLE DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "STUART",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-763-1717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "197033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7673541",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; 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.