Dermatology & Plastic Surgery of Northern New York PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

DERMATOLOGY & PLASTIC SURGERY OF NORTHERN NEW YORK PC

Practice address

826 Washington Street
Suite 104
Watertown, NY 13601-4065

Phone

(315) 786-1500

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Barbara Licznerski, MDNPI 1407825151

Title

President

Phone

(315) 786-1500

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Barbara Teresa Licznerski, MD

  • Specialist
  • Watertown, NY
  • NPI 1407825151
  NPD (past) Authorized official
• Adam Bogdan Licznerski, MD

  • Specialist
  • Watertown, NY
  • NPI 1447229869
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234915200000",
    "number": "1598852329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 91",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136010091",
            "telephone_number": "315-782-4207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 WASHINGTON STREET",
            "address_2": "SUITE 104",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014065",
            "telephone_number": "315-786-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & PLASTIC SURGERY OF NORTHERN NEW YORK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2009-02-18",
        "status": "A",
        "authorized_official_last_name": "LICZNERSKI",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-786-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NUMBER",
            "identifier": "AA0167",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael James Demianenko, DC
• Kelsy Dennie, LMSW
• Krista Lyn Dennis, PT
• Dental Devices, PC
• Angela Denton
• Amanda Derouchie, PTA
• Madison Elizabeth Derouin, MS, OTR/L
• Patricia L Desrosier, LPN
• Natalie Diaz
• Leon Lansing Dickinson

• Specialist in Watertown, NY
• Providers in Watertown, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; 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.