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CONNECTICUT SKIN INSTITUTE
NPI 1013263847
Dermatology - MOHS-Micrographic Surgery in Stamford, CT

Active since July 30, 2012CLIA Certified · 2 labs
2777 SUMMER ST STE 600, STAMFORD, CT 06905(203) 428-4440(901) 221-4916 Get Directions Write a Review

NPPES record last updated: June 11, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 11, 2023, Mar 3, 2021 (2 updates tracked since 2021).

About Connecticut Skin Institute NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CONNECTICUT SKIN INSTITUTE (NPI 1013263847) is a healthcare organization registered as a mohs-micrographic surgery in Stamford, Connecticut and active in the NPI registry since July 2012. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Milford, and lists Omar A Ibrahimi, Owner, as its authorized official.

NPPES Registry Identity

NPI1013263847
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameOMAR A IBRAHIMI MD PHD LLC
Location Address2777 SUMMER ST STE 600Stamford, CT 06905-4323
Mailing Address2777 Summer St Ste 600Stamford, CT 06905-4323 · (917) 301-3781 · Fax (901) 221-4916
Phone(203) 428-4440
Fax(901) 221-4916
Organization SubpartNo
Authorized OfficialOmar A IbrahimiOwner · (203) 428-4440
Enumeration DateJuly 30, 2012
Last NPPES UpdateJune 11, 20232 updates tracked since enumeration
NPPES CertifiedJune 11, 2023
✔ NPI 1013263847 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
License✔ Licensed in CT · 049530
Definition
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.
2777 SUMMER ST STE 600, Stamford, CT 06905
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Other Names 1

Doing Business AsConnecticut Skin Institute

Secondary Practice Location 1

Location 160 Commerce Park Ste CMilford, CT 06460-3513 · Phone (203) 428-4440 · Fax (901) 221-4916

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 07D2117686

Omar A Ibrahimi MD Phd LLC · Milford, CT
Active · expires Jun 11, 2027
CLIA Number07D2117686
Laboratory TypePhysician Office
Certificate Effective DateJune 12, 2025
Certificate Expiration DateJune 11, 2027
Laboratory DirectorOmar A. Ibrahimi MD Phd
Laboratory Phone(203) 428-4440
Laboratory LocationOmar A Ibrahimi MD Phd LLC60 Commerce Park Ste C, Milford, CT 06460
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 07D2045945

Omar A Ibrahimi Md,phd, LLC · Stamford, CT
Active · expires Feb 26, 2027
CLIA Number07D2045945
Laboratory TypePhysician Office
Certificate Effective DateFebruary 27, 2025
Certificate Expiration DateFebruary 26, 2027
Laboratory DirectorDr. Omar A. Ibrahimi MD Phd
Laboratory Phone(203) 428-4440
Laboratory LocationOmar A Ibrahimi Md,phd, LLC2777 Summer St Ste 600, Stamford, CT 06905
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FATIMA RAUF BAWANY MD
Dermatology
2777 SUMMER ST STE 600
STAMFORD, CT 06905
Western Connecticut Planning Region (203) 428-4440
OMAR A IBRAHIMI MD, PHD
Dermatology (MOHS-Micrographic Surgery)
2777 SUMMER ST STE 600
STAMFORD, CT 06905
Western Connecticut Planning Region (203) 428-4440
MATTHEW JAMES FEDULLO PA-C
Physician Assistant
2777 SUMMER ST STE 600
STAMFORD, CT 06905
Western Connecticut Planning Region (203) 428-4440

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Omar A Ibrahimi MD Phd LLC's NPI number?

The NPI number for Omar A Ibrahimi MD Phd LLC is 1013263847. It was assigned to this organization in the NPPES registry on July 30, 2012. The provider is doing business as Connecticut Skin Institute.

Where is Omar A Ibrahimi MD Phd LLC located?

Omar A Ibrahimi MD Phd LLC is located at 2777 Summer St Ste 600, Stamford, CT 06905. The listed phone number is (203) 428-4440.

What is Omar A Ibrahimi MD Phd LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Does Omar A Ibrahimi MD Phd LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Omar A Ibrahimi MD Phd LLC was last updated on June 11, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.