Dermatology Specialists of Pennsylvania

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY SPECIALISTS OF PENNSYLVANIA

Practice address

1122 Street Rd Ste 204
Southampton, PA 18966-4218

Phone

(415) 802-1310

Fax

(415) 579-3505

NPI assigned

Aug 5, 2020

Last updated

Aug 5, 2020By 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

Roman Bronfenbrener, MDNPI 1134488638

Title

Owner

Phone

(415) 802-1310

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

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.

• Roman Bronfenbrener, MD

  • Dermatology Physician
  • Southampton, PA
  • NPI 1134488638
  Medicare reassignment Care Compare group NPD Authorized official
• Corbett Berry, MD

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1851928568
  Medicare reassignment Care Compare group NPD
• Toni Bronfenbrener, CRNP

  • Nurse Practitioner
  • Southampton, PA
  • NPI 1740793215
  Medicare reassignment Care Compare group NPD
• Leo L Wang, MD, PHD

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1548898372
  Medicare reassignment Care Compare group NPD
• Roshell Tverskaya

  • Physician Assistant
  • Southampton, PA
  • NPI 1467221358
  Medicare reassignment Care Compare group
• Claire Kopylov, MSN, CRNP, FNP-C

  • Family Nurse Practitioner
  • Southampton, PA
  • NPI 1598425886
  Medicare reassignment NPD
• Christina M. Urday, PA-C

  • Dermatology Physician
  • Marlton, NJ
  • NPI 1801438312

  PA

  Medicare reassignment

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1790395747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 STREET RD STE 204",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189664218",
            "telephone_number": "415-802-1310",
            "fax_number": "415-579-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 STREET RD STE 204",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189664218",
            "telephone_number": "415-802-1310",
            "fax_number": "415-579-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY SPECIALISTS OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-05",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "BRONFENBRENER",
        "authorized_official_first_name": "ROMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "415-802-1310",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Southampton, PA
• Providers in Southampton, PA by specialty
• Dermatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.