Gold Coast Dermatology PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

GOLD COAST DERMATOLOGY PC

Practice address

149 Commack Rd Ste B
Commack, NY 11725-3459

Phone

(631) 467-4653

NPI assigned

May 25, 2021

Last updated

Aug 25, 2021By 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

Dr. Charisse L McCall, DONPI 1073802450

Title

President

Phone

(631) 467-4653

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00140

Practitioners 1

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.

• Charisse McCall, D.O.

  • Dermatology Physician
  • Commack, NY
  • NPI 1073802450
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1578138343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 COMMACK RD STE B",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253459",
            "telephone_number": "631-467-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 COMMACK RD STE B",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253459",
            "telephone_number": "631-467-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLD COAST DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "MCCALL",
        "authorized_official_first_name": "CHARISSE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-467-4653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03918898",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Glen R. Kreitzberg D.D.S.,P.C.
• Alisa Suzanne Glick, P.T.
• Charles W. Gluck, LCSW-R
• Mary Gnieser, LCSW
• Dakota Godek
• Gold Coast Physical Therapist and Physical Therapy Assistant PLLC (Gold Coast Physical Therapy and Sports Trainin)
• Brian Goldberg, PSY.D., BCBA-D
• Zoe Goldberg, MD
• Robert Goldman, PSY.D.
• Victoria Leigh Goldson, PT

• Dermatology Physician in Commack, NY
• Providers in Commack, 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 Aug 25, 2021; 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.