Active NPI
James Kenneth Herstoff, M.D.
- Dermatology Physician
- Newport, RI
National Provider Identifier
1710980461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MD04667
- Practice address
- 75 Gibbs Ave
Newport, RI 02840-2216 - Phone
- (401) 849-2223
- NPI assigned
- May 25, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MD04667 | RI | Primary |
Addresses
Primary practice location
75 Gibbs Ave
Newport, RI 02840-2216
Mailing address
75 Gibbs Ave
Newport, RI 02840-2216
Phone (401) 849-2223
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900709 | Medicaid | RI | |
| 0000000709 | Other | RI | BLUE CROSS BLUE SHIELD RI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD04667 | RI | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196640000000",
"number": "1710980461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 GIBBS AVE",
"city": "NEWPORT",
"state": "RI",
"postal_code": "028402216",
"telephone_number": "401-849-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 GIBBS AVE",
"city": "NEWPORT",
"state": "RI",
"postal_code": "028402216",
"telephone_number": "401-849-2223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERSTOFF",
"first_name": "JAMES",
"middle_name": "KENNETH",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-25",
"last_updated": "2007-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "RI",
"license": "MD04667",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "900709",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD RI",
"identifier": "0000000709",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.