NPIMap

Organization Active NPI

Park Avenue Dermatology

  • Legal Medicine
  • Staten Island, NY
National Provider Identifier
1447642103
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
018032 Issued in NY
Legal business name
PARK AVENUE DERMATOLOGY
Practice address
31 Tioga St
Staten Island, NY 10301
Phone
(718) 981-5040
NPI assigned
Mar 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

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

Authorized official

Name
Amanda Dick
Title
Ofice Manager
Phone
(718) 981-5040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193400000X SINGLE SPECIALTY GROUP 173000000X 018032 NY Primary

Addresses

Primary practice location

31 Tioga St
Staten Island, NY 10301

Mailing address

31 Tioga St
Staten Island, NY 10301
Phone (718) 981-5040

National Provider Directory

National Provider Directory
Tax ID family
Park Avenue Dermatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1447642103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 TIOGA ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10301",
            "telephone_number": "718-981-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 TIOGA ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10301",
            "telephone_number": "718-981-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "DICK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OFICE MANAGER",
        "authorized_official_telephone_number": "718-981-5040"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "018032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.