NPIMap

Organization Active NPI

North Shore Dermatology, S.C.

  • Dermatology Physician
  • Mequon, WI
National Provider Identifier
1649399080
Registry record updated Aug 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
NORTH SHORE DERMATOLOGY, S.C.
Practice address
10303 N Port Washington Rd
Suite 101
Mequon, WI 53092-5760
Phone
(262) 240-0440
Fax
(262) 240-0441
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2007

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

Authorized official

Name
Anthony Bonfiglio, MDNPI 1144319104
Title
Owner Physician
Phone
(262) 240-0440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

10303 N Port Washington Rd
Suite 101
Mequon, WI 53092-5760

Mailing address

10303 N Port Washington Rd
Suite 101
Mequon, WI 53092-5760
Phone (262) 240-0440

Other names 1

  • Drs. Meister and Bonfiglio, S.C. Former legal business name

National Provider Directory

National Provider Directory

Locations

10303 N Port Washington Rd
Ste 101
Mequon, WI 53092
Phone (262) 240-0440

10303 N Port Washington Rd
Mequon, WI 53092
Phone (262) 240-0440

10303 N Port Washington Rd
#S101
Mequon, WI 53092
Phone (262) 240-0440

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188518400000",
    "number": "1649399080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10303 N PORT WASHINGTON RD",
            "address_2": "SUITE 101",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925760",
            "telephone_number": "262-240-0440",
            "fax_number": "262-240-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10303 N PORT WASHINGTON RD",
            "address_2": "SUITE 101",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925760",
            "telephone_number": "262-240-0440",
            "fax_number": "262-240-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-08-31",
        "status": "A",
        "authorized_official_last_name": "BONFIGLIO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "262-240-0440",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Meister and Bonfiglio, S.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.