NPIMap

Organization Active NPI

Advanced Dermatology of New York, P.C.

  • Specialist
  • Bronx, NY
National Provider Identifier
1497017552
Registry record updated Dec 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ADVANCED DERMATOLOGY OF NEW YORK, P.C.
Practice address
1455 West Ave
Bronx, NY 10462-7304
Phone
(212) 262-2500
Fax
(212) 765-3210
NPI assigned
Jun 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2014

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

Authorized official

Name
Lawrence D Jaeger, D.O.
Title
Officer
Phone
(212) 262-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1455 West Ave
Bronx, NY 10462-7304

Mailing address

200 Central Park S
Suite 107
New York, NY 10019-1436
Phone (212) 262-2500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040325001709 NY Part B Supplier - Clinic/Group Practice 5193617082 Receives reassigned benefits from 14 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bronx, NY; New York, NY

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1339545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1497017552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CENTRAL PARK S",
            "address_2": "SUITE 107",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191436",
            "telephone_number": "212-262-2500",
            "fax_number": "212-765-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 WEST AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104627304",
            "telephone_number": "212-262-2500",
            "fax_number": "212-765-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF NEW YORK, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-13",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "JAEGER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "212-262-2500",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.