NPIMap

Organization Active NPI

Arizona Skin and Laser Therapy Institute, LTD

  • Dermatology Physician
  • Gilbert, AZ
National Provider Identifier
1760418008
Registry record updated Jan 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD
Practice address
4001 E Baseline Rd
Suite B-8
Gilbert, AZ 85234-2726
Phone
(480) 844-0510
Fax
(480) 844-1663
NPI assigned
Jun 25, 2006
Last updated
Jan 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2008

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

Authorized official

Name
Neil P Superfon, D.O.
Title
Owner/Physician
Phone
(602) 277-1449

Specialties & licenses 1

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

Addresses

Primary practice location

4001 E Baseline Rd
Suite B-8
Gilbert, AZ 85234-2726

Mailing address

2224 W Northern Ave
D 300
Phoenix, AZ 85021-4928
Phone (602) 277-1449

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000424 AZ Part B Supplier - Clinic/Group Practice 6204720626 Receives reassigned benefits from 17 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Apache Junction, AZ; Coolidge, AZ; Gilbert, AZ; Mesa, AZ; Phoenix, AZ; Quartzsite, AZ; Scottsdale, AZ; Show Low, AZ

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

4001 E Baseline Rd
Ste B8
Gilbert, AZ 85234
Phone (480) 844-0510

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200009600000",
    "number": "1760418008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 W NORTHERN AVE",
            "address_2": "D 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850214928",
            "telephone_number": "602-277-1449",
            "fax_number": "602-277-9984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 E BASELINE RD",
            "address_2": "SUITE B-8",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342726",
            "telephone_number": "480-844-0510",
            "fax_number": "480-844-1663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2008-01-11",
        "status": "A",
        "authorized_official_last_name": "SUPERFON",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "602-277-1449",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; 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.