Active NPI
Bernard S Potter, MD
- Dermatology Physician
- Dix Hills, NY
National Provider Identifier
1467535252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 96606
- Practice address
- 410 Wolf Hill Road
Dix Hills, NY 11746-5695 - Phone
- (631) 271-8850
- Fax
- (631) 271-8853
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 96606 | NY | Primary |
Addresses
Primary practice location
410 Wolf Hill Road
Dix Hills, NY 11746-5695
Mailing address
410 Wolf Hill Road
Dix Hills, NY 11746-5695
Phone (631) 271-8850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96606 | NY | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186012800000",
"number": "1467535252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 WOLF HILL ROAD",
"city": "DIX HILLS",
"state": "NY",
"postal_code": "117465695",
"telephone_number": "631-271-8850",
"fax_number": "631-271-8853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 WOLF HILL ROAD",
"city": "DIX HILLS",
"state": "NY",
"postal_code": "117465695",
"telephone_number": "631-271-8850",
"fax_number": "631-271-8853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "BERNARD",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2007-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NY",
"license": "96606",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dix Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.