NPIMap

Organization Active NPI

Advanced Dermatology, PLLC

  • Dermatology Physician
  • Kingston, NY
National Provider Identifier
1992725279
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ADVANCED DERMATOLOGY, PLLC
Practice address
301 Hurley Ave
Kingston, NY 12401-2416
Phone
(845) 339-2525
NPI assigned
Jul 20, 2006
Last updated
May 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2008

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

Authorized official

Name
Dr. Kenneth T Kircher, D.O.NPI 1417929217
Title
Owner
Phone
(845) 339-2525

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 Physician 207N00000X Primary

Addresses

Primary practice location

301 Hurley Ave
Kingston, NY 12401-2416

Mailing address

301 Hurley Ave
Kingston, NY 12401-2416
Phone (845) 339-2525

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060303000003 NY Part B Supplier - Clinic/Group Practice 0648286427 Receives reassigned benefits from 15 practitioners
Practice locations: Lake Katrine, NY

National Provider Directory

National Provider Directory

Locations

315 Grant Ave
Lake Katrine, NY 12449
Phone (845) 339-2525

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1992725279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HURLEY AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012416",
            "telephone_number": "845-339-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HURLEY AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012416",
            "telephone_number": "845-339-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "KIRCHER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-339-2525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; 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.