NPIMap

Organization Active NPI

Weill Medical College of Cornell

Doing business as Wcumc Dermatology GRP.

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1699723296
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
WEILL MEDICAL COLLEGE OF CORNELL
Doing business as
Wcumc Dermatology GRP.
Practice address
1305 York Ave
New York, NY 10021-5663
Phone
(212) 746-3016
Fax
(212) 746-8656
NPI assigned
May 5, 2006
Last updated
Jul 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

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

Authorized official

Name
Christopher T. Kells
Title
Associate Director
Phone
(212) 590-5741

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary
MOHS-Micrographic Surgery Physician 207ND0101X
Dermatopathology Physician 207ND0900X
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X
Pediatric Dermatology Physician 207NP0225X
Procedural Dermatology Physician 207NS0135X

Addresses

Primary practice location

1305 York Ave
New York, NY 10021-5663

Mailing address

575 Lexington Ave
Suite 540
New York, NY 10022-6102
Phone (212) 590-5710

Other identifiers 1

IdentifierTypeStateIssuer
02710369MedicaidNY

Other names 1

  • WCUMC DERMATOLOGY GRP. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000661 NY Part B Supplier - Clinic/Group Practice 6800709023 Receives reassigned benefits from 985 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20040501000028 NY Part B Supplier - Clinic/Group Practice 6800709023 Receives reassigned benefits from 290 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New York, NY; Rego Park, NY; Valhalla, NY; White Plains, NY; Yonkers, NY; New Rochelle, NY; Astoria, NY; Bronx, NY…

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 68

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.

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1699723296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 LEXINGTON AVE",
            "address_2": "SUITE 540",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100226102",
            "telephone_number": "212-590-5710",
            "fax_number": "212-590-5798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100215663",
            "telephone_number": "212-746-3016",
            "fax_number": "212-746-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEILL MEDICAL COLLEGE OF CORNELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "KELLS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "212-590-5741"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02710369",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WCUMC DERMATOLOGY GRP.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.