PENROSE DERMATOLOGY PLLC (NPI# 1346601333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346601333 |
| Entity Type | Organization |
| Organization Name | PENROSE DERMATOLOGY PLLC |
| Practice Address |
1110 South Ave Suite 400 Staten Island NY 10314-3403 |
| Practice Telephone | 9178301415 |
| Practice Fax Number | 9178301418 |
| Mailing Telephone | 9178301415 |
| Mailing Fax Number | 9178301418 |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2016-06-28 |
| Authorized Official Name | DR. CAROLIN PENROSE (DERMATOLOGIST) |
| Authorized Official Telephone | 9176204421 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
245597-1 | NY | Ambulatory Health Care Facilities |
| Street Address |
1110 SOUTH AVE SUITE 400 |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10314-3403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609860121 | Michele Cammarata | Family Medicine | 1110 South Ave, Suite 306, Staten Island, NY 10314-3403 | 2005-09-12 |
| 1891315677 | Brooke Randall | Early Intervention Provider Agency | 1110 South Ave, Staten Island, NY 10314-3403 | 2020-04-21 |
| 1114551363 | Alyssa Elizabeth Ryan | Social Worker | 1110 South Ave, Staten Island, NY 10314-3403 | 2020-02-26 |
| 1548822372 | Nicole Vento | Case Manager/Care Coordinator | 1110 South Ave, Suite 405, Staten Island, NY 10314-3414 | 2019-07-02 |
| 1336707033 | Edyta Knobloch | Counselor | 1110 South Ave, Staten Island, NY 10314-3403 | 2019-05-29 |
| 1649760141 | Ashley Santucci | Occupational Therapist | 1110 South Ave, Staten Island, NY 10314-3403 | 2018-05-10 |
| 1558866103 | Jennifer Colon | Case Manager/Care Coordinator | 1110 South Ave, Staten Island, NY 10314-3403 | 2018-03-27 |
| 1740795467 | John Mccahey | Specialist | 1110 South Ave, Staten Island, NY 10314-3403 | 2017-12-04 |
| 1083160170 | Jacqueline Shall-mccumiskey | Psychologist | 1110 South Ave, Suite 5, Staten Island, NY 10314-3403 | 2016-08-29 |
| 1790155372 | Laura Parisi | Counselor | 1110 South Ave, Suite 5, Staten Island, NY 10314-3403 | 2015-09-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076255 | Edward Leccese | Massage Therapist | 77 Renee Place, Staten Island, NY 10314 | 2020-09-01 |
| 1871154633 | Matthew Richard Puliatti | Counselor | 1688 Victory Boulevard, Staten Island, NY 10314 | 2019-06-24 |
| 1750845137 | Miriam Gordon Pediatric Np PC | Nurse Practitioner | 7 Ismay Street, Staten Island, NY 10314 | 2019-01-30 |
| 1003391186 | 2791 Richmond LLC | Dentist | 2791 Richmond Avenue, Suite 2, Staten Island, NY 10314 | 2018-09-25 |
| 1477046522 | Miriam A Madry | Optometrist | 569 Woolley Ave, Staten Island, NY 10314 | 2018-06-13 |
| 1174025894 | Staten Island Dentistry P.C. | Clinic/Center | 979 Willowbrook Rd., Staten Island, NY 10314 | 2018-03-08 |
| 1205335023 | Ashley Larsen | Early Intervention Provider Agency | 229 Wellington Ct, Staten Island, NY 10314 | 2018-02-07 |
| 1306369699 | Victoria Ali | Behavior Technician | 228 Melvin Avenue, Staten Island, NY 10314 | 2017-07-19 |
| 1700307360 | Lydia Mora | Specialist | 2025 Richmond Avenue Suite 200, Staten Island, NY 10314 | 2017-07-03 |
| 1366971707 | Lisa Pietracatella | Massage Therapist | 92 Margaretta Court, Staten Island, NY 10314 | 2017-06-08 |
| Find all providers in zip 10314 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| Find all providers with the same taxonomy | ||||
| City | STATEN ISLAND |
| Zip Code | 10314 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.