Brookline Dermatology Associates, PC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

57991 Issued in MA

Legal business name

BROOKLINE DERMATOLOGY ASSOCIATES, PC

Practice address

235 Cypress St
Suite 200
Brookline, MA 02445-6776

Phone

(617) 277-0800

Fax

(617) 277-0899

NPI assigned

Sep 18, 2014

Last updated

Sep 18, 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

Maryjane Mushow

Title

Chief Operating Officer

Phone

(617) 608-1575

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1811399025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208B VFW PKWY",
            "address_2": "SUTIE 200",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324349",
            "telephone_number": "617-608-1575",
            "fax_number": "617-605-1576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 CYPRESS ST",
            "address_2": "SUITE 200",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024456776",
            "telephone_number": "617-277-0800",
            "fax_number": "617-277-0899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKLINE DERMATOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "MUSHOW",
        "authorized_official_first_name": "MARYJANE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "617-608-1575"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MA",
            "license": "57991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• MOHS-Micrographic Surgery Physician in Brookline, MA
• Providers in Brookline, MA by specialty
• MOHS-Micrographic Surgery Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.