EMPIRE DERMATOLOGY PLLC
NPI 1336698406
Dermatology - MOHS-Micrographic Surgery in East Syracuse, NY
NPI Status: Active since September 29, 2016
Contact Information
5823 WIDEWATERS PKWY
SUITE 4
EAST SYRACUSE, NY
ZIP 13057
Phone: (315) 500-7546
Fax: (888) 454-8316
- Organization
- Dermatology
- MOHS-Micrographic Surgery
- CLIA Number: 33D2283263
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 06-04-2027
About EMPIRE DERMATOLOGY PLLC
This page provides the complete NPI Profile along with additional information for Empire Dermatology Pllc, a provider established in East Syracuse, New York operating as a Dermatology, focusing in mohs-micrographic surgery . The healthcare provider is registered in the NPI registry with number 1336698406 assigned on September 2016. The practitioner's primary taxonomy code is 207ND0101X with license number 282257 (NY). The provider is registered as an organization and their NPI record was last updated 2 years ago. Empire Dermatology Pllc operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Ms. Patricia H Madden (Practice Manager)
- NPI
- 1336698406
- Provider Name
- EMPIRE DERMATOLOGY PLLC
- Entity Type
- Organization
- Location Address
- 5823 WIDEWATERS PKWY SUITE 4 EAST SYRACUSE, NY 13057
- Location Phone
- (315) 500-7546
- Location Fax
- (888) 454-8316
- Mailing Address
- 5823 WIDEWATERS PKWY SUITE 4 EAST SYRACUSE, NY 13057
- Mailing Phone
- (315) 500-7546
- Mailing Fax
- (888) 454-8316
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-29-2016
- Last Update Date
- 03-16-2023
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dermatology MOHS-Micrographic Surgery
- Taxonomy Code
- 207ND0101X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 282257
- License State
- NY
- Taxonomy Description
- The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | |
| 2 | 207ND0101X | Allopathic & Osteopathic Physicians | Dermatology |
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 33D2283263
- Facility Type
- Physician Office
- Certificate Effective Date
- June 05, 2025
- Certificate Expiration Date
- June 04, 2027
- Laboratory Director
- DR. BRIAN A. RAPHAEL
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Empire Dermatology Pllc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 3 | 3 | 6 | 6 | 9 | 8 | 4 | 0 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 3 | 6 | 6 | 12 | 9 | 16 | 4 | 0 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 3 + 6 + 6 + 1 + 2 + 9 + 1 + 6 + 4 + 0 + 24 = 64 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 64 = 6 | 6 | ||||||||
The NPI number 1336698406 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1750371548 | DR. ROBERT C CUPELO M.D. Individual | Internal Medicine | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 449-4028 |
| 1598748956 | JOSEPH PINKES M.D. Individual | Internal Medicine | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 449-4028 |
| 1831165109 | HILLARY TUPPER RPA Individual | Physician Assistant | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 449-4028 |
| 1386990638 | CROUSE MEDICAL PRACTICE PLLC Organization | Physician Assistant | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 474-6824 |
| 1104925833 | RENEE S MELFI MD Individual | Physical Medicine & Rehabilitation (Pain Medicine) | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 701-4000 |
| 1215219167 | RSM MEDICAL ASSOCIATES, PLLC Organization | Orthopaedic Surgery | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 426-0190 |
| 1083024327 | MARK RUSSO ATC, CSCS Individual | Specialist/Technologist (Athletic Trainer) | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 701-4000 |
| 1609249028 | MRS. LAURA LYNN KIRKPATRICK MS PT Individual | Physical Therapist (Orthopedic) | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 418-4000 |
| 1205121324 | BRIAN RAPHAEL M.D. Individual | Dermatology (MOHS-Micrographic Surgery) | 5823 WIDEWATERS PKWY SUITE 4 EAST SYRACUSE, NY 13057 (315) 500-7546 |
| 1619412947 | CAROLYN MCGOVERN OT Individual | Occupational Therapist | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 418-4013 |
| 1912300880 | MEGAN KEATING PT Individual | Physical Therapist | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 418-4013 |
| 1598276867 | BRETT POIRIER DPT Individual | Physical Therapist | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 418-4025 |
| 1396398566 | RACHEL DORRER Individual | Physician Assistant | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 500-7546 |
| 1477973824 | SYRACUSE ORTHOPEDIC SPECIALISTS, PC Organization | Orthopaedic Surgery | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 251-3100 |
| 1780095455 | SYRACUSE ORTHOPEDIC SPECIALISTS, PC Organization | Physical Therapist | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 251-3100 |
| 1275583486 | CNY INTERNISTS, PC Organization | Internal Medicine | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 449-4028 |
| 1093093478 | HEIDI LEIGH DIMEIS NP Individual | Nurse Practitioner | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 500-7546 |
| 1710419379 | MARK MCKINLEY ASH M.D. Individual | Dermatology | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 500-7546 |
| 1235649872 | MARGARET DRESCHER PA Individual | Physician Assistant | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 500-7546 |
| 1114457504 | CONNOR DELANEY DPT Individual | Physical Therapist | 5823 WIDEWATERS PKWY EAST SYRACUSE, NY 13057 (315) 418-4013 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1336698406, enumerated in the NPI registry as an "organization" on September 29, 2016
The provider is located at 5823 Widewaters Pkwy Suite 4 East Syracuse, Ny 13057 and the phone number is (315) 500-7546
This medical organization specializes in Dermatology with taxonomy code 207ND0101X with a focus in MOHS-Micrographic Surgery
The provider's CLIA number is 33D2283263 for a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing..
This NPI record was last updated on September 29, 2016. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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