Organization Active NPI

Huntington Dermatology and Cosmetics Associate PC

  • Dermatology Physician
  • Huntington, NY
National Provider Identifier
1487669883
Registry record updated Sep 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
152208 Issued in NY
Legal business name
HUNTINGTON DERMATOLOGY AND COSMETICS ASSOCIATE PC
Practice address
11 Prospect St
Huntington, NY 11743
Phone
(631) 424-3376
Fax
(631) 424-0199
NPI assigned
Jul 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2007

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

Authorized official

Name
Dr. Phyllis J Smith
Title
Owner
Phone
(631) 424-3376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 152208 NY Primary

Addresses

Primary practice location

11 Prospect St
Huntington, NY 11743

Mailing address

11 Prospect St
Huntington, NY 11743
Phone (631) 424-3376

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060228000363 NY Part B Supplier - Clinic/Group Practice 4981610938 Receives reassigned benefits from 3 practitioners
Practice locations: Huntington, NY

National Provider Directory

National Provider Directory

Locations

200 W Carver St
Ste 200
Huntington, NY 11743

200 W Carver St
Ste 2
Huntington, NY 11743
Phone (631) 424-3376

11 Prospect St
Huntington, NY 11743
Phone (631) 424-3376

Practitioners & affiliated clinicians

Practitioners 7

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": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190851200000",
    "number": "1487669883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 PROSPECT ST",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "11743",
            "telephone_number": "631-424-3376",
            "fax_number": "631-424-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 PROSPECT ST",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "11743",
            "telephone_number": "631-424-3376",
            "fax_number": "631-424-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUNTINGTON DERMATOLOGY AND COSMETICS ASSOCIATE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-09-27",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-424-3376",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "152208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.