Center for Dermatology, Laser and Cosmetic Surgery LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD032429E Issued in PA

Legal business name

CENTER FOR DERMATOLOGY, LASER AND COSMETIC SURGERY LLC

Practice address

9892 Bustleton Ave
Suite 204
Philadelphia, PA 19115-2184

Phone

(215) 676-2464

Fax

(215) 676-5536

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Harold Farber, M.D.NPI 1194833590

Title

Owner

Phone

(215) 676-2464

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Harold Farber, M.D,

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1194833590
  Medicare reassignment Care Compare group NPD Authorized official
• Carl Howard Manstein, MD

  • Plastic Surgery Physician
  • Huntingdon Valley, PA
  • NPI 1861441644
  Medicare reassignment Care Compare group NPD
• Yongming Li, MD, PHD, AC

  • Anatomic Pathology & Clinical Pathology Physician
  • Bridgewater, NJ
  • NPI 1124141478

  PA

  Medicare reassignment Care Compare group NPD
• Leila Driansky, MD

  • Surgery Physician
  • Philadelphia, PA
  • NPI 1275063794
  Medicare reassignment Care Compare group
• Marisa Frances Baldassano, M.D.

  • Dermatopathology Physician
  • Lower Gwynedd, PA
  • NPI 1013965011
  Medicare reassignment NPD
• Wei T Hsu, M.D.

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1497713556
  NPD (past)
• Sara Mancini, P.A.

  • Dermatology Physician
  • Bryn Mawr, PA
  • NPI 1790972305
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360540800000",
    "number": "1942340542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 MONTGOMERY AVE",
            "address_2": "SUITE 100",
            "city": "NARBERTH",
            "state": "PA",
            "postal_code": "190721937",
            "telephone_number": "610-664-4433",
            "fax_number": "610-664-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9892 BUSTLETON AVE",
            "address_2": "SUITE 204",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191152184",
            "telephone_number": "215-676-2464",
            "fax_number": "215-676-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR DERMATOLOGY, LASER AND COSMETIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2013-02-11",
        "status": "A",
        "authorized_official_last_name": "FARBER",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-676-2464",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD032429E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101436700001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "CE1764878",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "095922",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "2430802000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; 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.