The Institute of Dermatology and Mohs Surgery, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

THE INSTITUTE OF DERMATOLOGY AND MOHS SURGERY, PLLC

Practice address

2650 W State Road 434
Longwood, FL 32779-4815

Phone

(407) 475-3366

Fax

(407) 475-3367

NPI assigned

Oct 12, 2026

Last updated

Oct 13, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pushpal Banerjee, DO

Title

Owner

Phone

(407) 475-3366

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1791763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791849600000",
    "number": "1508761222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 W STATE ROAD 434",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327794815",
            "telephone_number": "407-475-3366",
            "fax_number": "407-475-3367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 W STATE ROAD 434",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327794815",
            "telephone_number": "407-475-3366",
            "fax_number": "407-475-3367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE INSTITUTE OF DERMATOLOGY AND MOHS SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-12",
        "last_updated": "2026-10-13",
        "certification_date": "2026-10-13",
        "status": "A",
        "authorized_official_last_name": "BANERJEE",
        "authorized_official_first_name": "PUSHPAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-475-3366",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2026; 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.