Advanced Dermatology of New York PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ADVANCED DERMATOLOGY OF NEW YORK PC

Practice address

291 E 149TH St
Bronx, NY 10451-5601

Phone

(718) 742-1000

Fax

(212) 765-3210

NPI assigned

Dec 5, 2007

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• advanced dermatology associates Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

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

• Advanced Dermatology of New York PC

  • Dermatology Physician
  • New York, NY
  • NPI 1083610521

  O20040325001709

  Same enrollment
• Advanced Dermatology of New York PC

  • Dermatology Physician
  • Bronx, NY
  • NPI 1518964923

  O20040325001709

  Same enrollment
• Advanced Dermatology of New York PC

  • Dermatology Physician
  • New York, NY
  • NPI 1588214357

  O20040325001709

  Same enrollment
• Advanced Dermatology of New York, P.C.

  • Specialist
  • Bronx, NY
  • NPI 1497017552

  O20040325001709

  Same enrollment
• Advanced Dermatology of New York, PC

  • Specialist
  • Bronx, NY
  • NPI 1598195695

  O20040325001709

  Same enrollment

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Edward Bloom, M.D.

  • Dermatology Physician
  • Bronx, NY
  • NPI 1477536068
  NPD
• Peter Hu, PA-C

  • Medical Physician Assistant
  • Brooklyn, NY
  • NPI 1194066266
  NPD
• Angela America Libranti, PA

  • Physician Assistant
  • Bronx, NY
  • NPI 1497240675
  NPD

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418169600000",
    "number": "1508048240",
    "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": "291 E 149TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515601",
            "telephone_number": "718-742-1000",
            "fax_number": "212-765-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF NEW YORK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2014-12-10",
        "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": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1508048240",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "advanced dermatology associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.