Dermatology Associates of the Northeast, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY ASSOCIATES OF THE NORTHEAST, PC

Practice address

745A Route 63
Chesterfield, NH 03443-3604

Phone

(800) 303-8984

Fax

(603) 363-4450

NPI assigned

May 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jorge Luis Crespo, MDNPI 1881633568

Title

President

Phone

(800) 303-8984

Specialties & licenses 1

Addresses

Other identifiers 5

Practitioners 7

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

• Jorge Luis Crespo, MD

  • Dermatology Physician
  • Chesterfield, NH
  • NPI 1881633568
  NPD (past) Authorized official
• Lisa Davey Ahava, PA

  • Physician Assistant
  • Chesterfield, NH
  • NPI 1487693453
  NPD (past)
• Meena K Moorthy, MD

  • Diagnostic Radiology Physician
  • Lebanon, NH
  • NPI 1760691489
  NPD (past)
• Charles Casale, MD

  • Gastroenterology Physician
  • Cooperstown, NY
  • NPI 1811074636
  NPD (past)
• Emily J Fisher, M.D.

  • Dermatology Physician
  • Cincinnati, OH
  • NPI 1578670147
  NPD (past)
• Amy-Lyn Gumprecht, P.A.

  • Physician Assistant
  • Greenfield, MA
  • NPI 1558377093
  NPD (past)
• Rebecca M Jones, MD

  • Dermatology Physician
  • Brattleboro, VT
  • NPI 1861432841
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1558314542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 910",
            "city": "GREENFIELD",
            "state": "MA",
            "postal_code": "013020910",
            "telephone_number": "413-772-8500",
            "fax_number": "413-772-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745A ROUTE 63",
            "city": "CHESTERFIELD",
            "state": "NH",
            "postal_code": "034433604",
            "telephone_number": "800-303-8984",
            "fax_number": "603-363-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF THE NORTHEAST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "CRESPO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-303-8984",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN2029",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30003577",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "8233",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "0104793Y0VT01",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30212525",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Davey Ahava, PA
• Jorge Luis Crespo, MD
• Integrated Dermatology of Chesterfield LLC

• Dermatology Physician in Chesterfield, NH
• Providers in Chesterfield, NH by specialty
• Dermatology Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.