Active NPI
Kathleen Vine MD PC
- Dermatology Physician
- New York, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 2628951
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathleen R Vine
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 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
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2628951 | Other | NY | STATE LISCENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
9 E 8th St
#255
New York, NY 10003
928 Broadway
Ste 401
New York, NY 10010
Phone (646) 242-5733
928 Broadway
Ste 301
New York, NY 10010
Phone (646) 421-6064
24 E 12th St
#304
New York, NY 10003
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.
-
- Family Nurse Practitioner
- Amagansett, NY
- NPI 1619352515
NY
-
- MOHS-Micrographic Surgery Physician
- Hackensack, NJ
- NPI 1790878866
Dermatology, NY
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": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LISCENSE",
"identifier": "2628951",
"state": "NY"
}
],
"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.