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

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Group Taxonomy
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

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
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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 MOHS-Micrographic Surgery

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.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: MS. PATRICIA H MADDEN
Authorized Official Title: PRACTICE MANAGER
Authorized Official Phone: (315) 935-9247

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.

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.

DR. ROBERT C CUPELO M.D.

Internal Medicine

5823 WIDEWATERS PKWY
EAST SYRACUSE, NY
ZIP 13057

About EMPIRE DERMATOLOGY PLLC

Location Map

Specialty - Primary Taxonomy

Dermatology MOHS-Micrographic Surgery

Secondary Taxonomies

Dermatology

Dermatology MOHS-Micrographic Surgery

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

Authorized Official

MS. PATRICIA H MADDEN

CLIA Information

Reviews for EMPIRE DERMATOLOGY PLLC

NPI Validation Check Digit Calculation

Other Providers at the Same Location

Frequently Asked Questions

What is EMPIRE DERMATOLOGY PLLC's NPI number?

Where is the provider located?

What is the provider's specialty?

Dermatology
MOHS-Micrographic Surgery