NPIMap

Organization Active NPI

New Age Dermatology Inc

  • Dermatology Physician
  • West Palm Beach, FL
National Provider Identifier
1962586586
Registry record updated Sep 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
NEW AGE DERMATOLOGY INC
Practice address
1411 N Flagler Dr
Suite 3900
West Palm Beach, FL 33401-3404
Phone
(561) 805-9399
Fax
(561) 805-9866
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2012

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

Authorized official

Name
Supriya Tomar, MDNPI 1053332130
Title
Owner
Phone
(561) 805-9399

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 Primary

Addresses

Primary practice location

1411 N Flagler Dr
Suite 3900
West Palm Beach, FL 33401-3404

Mailing address

1411 N Flagler Dr
Suite 3900
West Palm Beach, FL 33401-3404
Phone (561) 805-9399

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070515000675 FL Part B Supplier - Clinic/Group Practice 2769483098 Receives reassigned benefits from 4 practitioners
Practice locations: Jupiter, FL; West Palm Beach, FL

National Provider Directory

National Provider Directory

Locations

641 University Blvd
Ste 109
Jupiter, FL 33458
Phone (561) 805-9399

1411 N Flagler Dr
Ste 3900
West Palm Beach, FL 33401
Phone (561) 805-9399

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1962586586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 N FLAGLER DR",
            "address_2": "SUITE 3900",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334013404",
            "telephone_number": "561-805-9399",
            "fax_number": "561-805-9866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 N FLAGLER DR",
            "address_2": "SUITE 3900",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334013404",
            "telephone_number": "561-805-9399",
            "fax_number": "561-805-9866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW AGE DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "TOMAR",
        "authorized_official_first_name": "SUPRIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-805-9399",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; 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.