CLOUDLAKE DERMATOLOGY PLLC
NPI 1083164354
Dermatology in Jericho, NY

Active since October 10, 2016
400 N BROADWAY, JERICHO, NY 11753(516) 992-6350 Get Directions Write a Review

NPPES record last updated: November 20, 2017. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Nov 20, 2017, Oct 10, 2016 (2 updates tracked since 2016).

About Cloudlake Dermatology Pllc NPPES

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

CLOUDLAKE DERMATOLOGY PLLC (NPI 1083164354) is a healthcare organization registered as a dermatology in Jericho, New York and active in the NPI registry since October 2016. The organization lists Sarika Banker, Owner, as its authorized official.

NPPES Registry Identity

NPI1083164354
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameCLOUDLAKE DERMATOLOGY PLLC
Location Address400 N BROADWAYJericho, NY 11753-2113
Mailing Address400 N BroadwayJericho, NY 11753-2113 · (516) 992-6350 · Fax (516) 992-6346
Organization SubpartNo
Authorized OfficialSarika BankerOwner · (516) 992-6350
Enumeration DateOctober 10, 2016
Last NPPES UpdateNovember 20, 20172 updates tracked since enumeration
✔ NPI 1083164354 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in NY · 263656-1
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
400 N BROADWAY, Jericho, NY 11753

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cloudlake Dermatology Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Cloudlake Dermatology PLLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Dermatology
NPI 1639330855
400 N BROADWAY
Jericho, NY 11753
(516) 992-6350
✔ PECOS✔ Accepts Medicare0.2 mi
Dermatology
NPI 1225419047
400 N BROADWAY
Jericho, NY 11753
(516) 992-6350
✔ PECOS✔ Accepts Medicare0.2 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Cloudlake Dermatology PLLC's NPI number?

The NPI number for Cloudlake Dermatology PLLC is 1083164354. It was assigned to this organization in the NPPES registry on October 10, 2016.

Where is Cloudlake Dermatology PLLC located?

Cloudlake Dermatology PLLC is located at 400 N Broadway, Jericho, NY 11753. The listed phone number is (516) 992-6350.

What is Cloudlake Dermatology PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Cloudlake Dermatology PLLC enrolled in Medicare?

Yes. Cloudlake Dermatology PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Cloudlake Dermatology PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dermatology, reassign their Medicare billing to Cloudlake Dermatology PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Cloudlake Dermatology PLLC was last updated on November 20, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.