Farmington Valley Dermatology and Surgery, LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

FARMINGTON VALLEY DERMATOLOGY AND SURGERY, LLC

Practice address

2400 Tamarack Ave Ste 203
South Windsor, CT 06074-5559

Phone

(860) 674-9900

NPI assigned

Mar 13, 2024

Organization subpart

Yes

Parent organization

FARMINGTON VALLEY DERMATOLOGY & SURGERYAs reported in NPPES

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

Authorized official

Name

Sadaf Waqar, DO

Title

Owner/Provider

Phone

(860) 674-9900

Specialties & licenses 1

Addresses

Other names 2

• FARMINGTON VALLEY DERMATOLOGY &SURGERY Former legal business name
• FVDS Former legal business name

Part of

Farmington Valley Dermatology and Surgery LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Farmington Valley Dermatology and Surgery, LLC

  • Dermatology Physician
  • Avon, CT
  • NPI 1164835153
  NPPES parent name

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

{
    "created_epoch": "1710288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1992563902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 W AVON RD",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 TAMARACK AVE STE 203",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745559",
            "telephone_number": "860-674-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARMINGTON VALLEY DERMATOLOGY AND SURGERY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FARMINGTON VALLEY DERMATOLOGY & SURGERY",
        "enumeration_date": "2024-03-13",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "WAQAR",
        "authorized_official_first_name": "SADAF",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "860-674-9900",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FARMINGTON VALLEY DERMATOLOGY &SURGERY",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "FVDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Non-Pharmacy Dispensing Site in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Non-Pharmacy Dispensing Site in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; 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.