NPIMap

Organization Active NPI

Kathleen Vine MD PC

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1942612866
Registry record updated May 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
2628951 Issued in NY
Legal business name
KATHLEEN VINE MD PC
Practice address
24 E 12TH St # 304
New York, NY 10003-4513
Phone
(646) 421-6064
NPI assigned
May 27, 2014
Last updated
May 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2014

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

Authorized official

Name
Kathleen R VineNPI 1659534410
Title
MD
Phone
(646) 421-6064

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 2628951 NY Primary

Addresses

Primary practice location

24 E 12TH St # 304
New York, NY 10003-4513

Mailing address

24 E 12TH St # 304
New York, NY 10003-4513

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141120000402 NY Part B Supplier - Clinic/Group Practice 8921220310 Receives reassigned benefits from 12 practitioners
Practice locations: New York, NY; Breezy Point, NY

National Provider Directory

National Provider Directory

Locations

24 E 12th St
#304
New York, NY 10003
Phone (646) 421-6064

9 E 8th St
#255
New York, NY 10003

928 Broadway
Ste 401
New York, NY 10010
Phone (646) 242-5733

20408 Rockaway Point Blvd
Rockaway Point, NY 11697
Phone (646) 421-6064

Practitioners & affiliated clinicians

Practitioners 12

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": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1942612866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 E 12TH ST # 304",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100034513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 E 12TH ST # 304",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100034513",
            "telephone_number": "646-421-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN VINE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "VINE",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "646-421-6064"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "2628951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.