NPIMap

Organization Active NPI

Skin Docs, LLC

  • Family Medicine Physician
  • Fairfield, CT
National Provider Identifier
1538415369
Registry record updated Sep 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SKIN DOCS, LLC
Practice address
2321 Black Rock Tpke
Hall 2
Fairfield, CT 06825-3220
Phone
(404) 805-2290
Fax
(203) 372-0506
NPI assigned
Jul 30, 2012
Last updated
Sep 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2014

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

Authorized official

Name
Louis Mazzella, MDNPI 1508029323
Title
Sole Member
Phone
(404) 805-2290

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X CT Primary
Surgery Physician 208600000X CT

Addresses

Primary practice location

2321 Black Rock Tpke
Hall 2
Fairfield, CT 06825-3220

Mailing address

2321 Black Rock Tpke
Hall 2
Fairfield, CT 06825-3220
Phone (404) 805-2290

National Provider Directory

National Provider Directory

Locations

2321 Black Rock Tpke
#2
Fairfield, CT 06825
Phone (203) 372-7445

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411084800000",
    "number": "1538415369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 BLACK ROCK TPKE",
            "address_2": "HALL 2",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068253220",
            "telephone_number": "404-805-2290",
            "fax_number": "203-372-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 BLACK ROCK TPKE",
            "address_2": "HALL 2",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068253220",
            "telephone_number": "404-805-2290",
            "fax_number": "203-372-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN DOCS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-30",
        "last_updated": "2014-09-19",
        "status": "A",
        "authorized_official_last_name": "MAZZELLA",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "404-805-2290",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; 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.