New Preston Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

NEW PRESTON DERMATOLOGY, LLC

Practice address

18 E Shore Rd
New Preston, CT 06777-1628

Phone

(484) 868-9998

Fax

(860) 393-1079

NPI assigned

May 12, 2021

Last updated

Jun 24, 2021By 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

Andreas Boker, MDNPI 1306972120

Title

Medical Director

Phone

(917) 902-0540

Specialties & licenses 1

Addresses

Electronic endpoints 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 2

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.

• Andreas Boker, M.D

  • MOHS-Micrographic Surgery Physician
  • New York, NY
  • NPI 1306972120

  CT

  Medicare reassignment Care Compare group NPD Authorized official
• Brent Denman Wainwright, MD

  • Dermatology Physician
  • New Preston, CT
  • NPI 1598737462
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1407430655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 E SHORE RD",
            "city": "NEW PRESTON",
            "state": "CT",
            "postal_code": "067771628",
            "telephone_number": "484-868-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 E SHORE RD",
            "city": "NEW PRESTON",
            "state": "CT",
            "postal_code": "067771628",
            "telephone_number": "484-868-9998",
            "fax_number": "860-393-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW PRESTON DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "BOKER",
        "authorized_official_first_name": "ANDREAS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "917-902-0540",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "newprestondermatology@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "useOtherDescription": "email",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "xls",
            "address_1": "18 E Shore Rd",
            "city": "New Preston",
            "state": "CT",
            "country_code": "US",
            "postal_code": "067771628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Denise A Good
• Robert E. Kane, O.D.
• Abra Grize Mabasa, MD
• Lisa McCarthy-Moore
• Pauline A Miller, LCSW
• Robert Edward O'Keefe
• Psychotherapy Care, LLC
• Robert E. Kane OD
• Henrietta Small
• Joseph E Struckus, PH.D.

• Dermatology Physician in New Preston, CT
• Providers in New Preston, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.