Unknown Individual – Procedural Dermatology Physician, NPI 1912901695
Procedural Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
453 DERMATOLOGY in NJ
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Provider Addresses for Unknown Individual
Market Street, Passaic Junction, Saddle Brook, Bergen County, New Jersey, 07663, United States
SADDLE BROOK, NJ 076634843
Phone: (201) 368-0011
Fax: (201) 368-2380
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 21 Open Payments records for all available years, with a total value of $290.
Total Amount is formed as General ($290) + Research ($0) + Ownership ($0) = $290.
Last reported payment date: 2024-12-23 • Largest payer in this snapshot: LEO Pharma Inc. ($143).
Total Amount
$290
General + Research + Ownership
Payments
21
Total payment records
General Amount
$290
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| LEO Pharma Inc. | $143 |
| Regeneron Healthcare Solutions, Inc. | $96 |
| STRATA Skin Sciences, Inc. | $51 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2008-01-14
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20080114000017 | I | Dermatology | NJ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 367 | 109 | $0 |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 346 | 85 | $0 |
| 11303 | Shaving of skin growth of body, arms, or legs, more than 2.0 cm | 151 | 45 | $0 |
| 17004 | Destruction of precancer skin growth, 15 or more growths | 129 | 48 | $0 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 71 | 14 | $0 |
Insurance plans in this area (ZIP 07663)
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