Mack Dermatology, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

245368 Issued in NY

Legal business name

MACK DERMATOLOGY, P.C.

Doing business as

GlamDerm

Practice address

130 E 18TH St
Suite 1U
New York, NY 10003-2416

Phone

(917) 912-3615

NPI assigned

Dec 4, 2014

Last updated

Dec 4, 2014By 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. Lian A Mack, M.D.NPI 1083878623

Title

Owner

Phone

(917) 912-3615

Specialties & licenses 1

Addresses

Other names 1

• GlamDerm Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 6

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.

• Lian Alana Mack, MD

  • Dermatology Physician
  • New York, NY
  • NPI 1083878623
  Medicare reassignment Authorized official
• Ella Glaser, MD

  • Dermatology Physician
  • New York, NY
  • NPI 1841852647
  NPD
• Leah Helen Ansell, M.D.

  • Dermatology Physician
  • Orangeburg, NY
  • NPI 1114260429
  NPD (past)
• Elyse Monique Love, M.D.

  • Dermatology Physician
  • New York, NY
  • NPI 1891174603
  NPD (past)
• Arpy Jitendra Kothari, PA

  • Physician Assistant
  • Georgetown, TX
  • NPI 1134504202
  NPD (past)
• Nicole Malfitano

  • Physician Assistant
  • Wilmington, NC
  • NPI 1689096547
  NPD (past)

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

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1720485808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E 18TH ST",
            "address_2": "SUITE 1U",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100032416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E 18TH ST",
            "address_2": "SUITE 1U",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100032416",
            "telephone_number": "917-912-3615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACK DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "LIAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-912-3615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "245368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GlamDerm",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alison Maciocia, MS, PA-C
• Laura Macisaac, MD
• Molly Macisaac
• Ryan Matthew Macisaac, MD
• Sarah Maciver, OD
• Charles Mack, MD
• Denise Marie Mack, R.N.
• Dianne Mack
• Erin Mack
• Ethan Andrew Mack, MD, PHD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.