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PENROSE DERMATOLOGY PLLC
NPI 1346601333
Clinic/Center - Medical Specialty in Staten Island, NY

Active since March 17, 2016
1110 SOUTH AVE, SUITE 400, STATEN ISLAND, NY 10314(917) 830-1415(917) 830-1418 Get Directions Write a Review

NPPES record last updated: June 28, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 28, 2016, Mar 17, 2016 (2 updates tracked since 2016).

About Penrose Dermatology Pllc NPPES

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

PENROSE DERMATOLOGY PLLC (NPI 1346601333) is a healthcare organization registered as a medical specialty in Staten Island, New York and active in the NPI registry since March 2016. The organization lists Carolin Penrose, Dermatologist, as its authorized official.

NPPES Registry Identity

NPI1346601333
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NamePENROSE DERMATOLOGY PLLC
Location Address1110 SOUTH AVE, SUITE 400Staten Island, NY 10314-3403
Mailing Address1110 South Ave, Suite 400Staten Island, NY 10314-3403 · (917) 830-1415 · Fax (917) 830-1418
Phone(917) 830-1415
Fax(917) 830-1418
Organization SubpartNo
Authorized OfficialCarolin PenroseDermatologist · (917) 620-4421
Enumeration DateMarch 17, 2016
Last NPPES UpdateJune 28, 20162 updates tracked since enumeration
✔ NPI 1346601333 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in NY · 245597-1
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
1110 SOUTH AVE, Staten Island, NY 10314
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Penrose Dermatology PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Carolin Penrose, M.D.
Dermatology
NPI 1790946655
1110 SOUTH AVE SUITE 400
Staten Island, NY 10314
(917) 830-1415
✔ PECOS✔ Accepts MedicareSame address

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 Penrose Dermatology PLLC's NPI number?

The NPI number for Penrose Dermatology PLLC is 1346601333. It was assigned to this organization in the NPPES registry on March 17, 2016.

Where is Penrose Dermatology PLLC located?

Penrose Dermatology PLLC is located at 1110 South Ave Suite 400, Staten Island, NY 10314. The listed phone number is (917) 830-1415.

What is Penrose Dermatology PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Is Penrose Dermatology PLLC enrolled in Medicare?

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

How many clinicians bill Medicare through Penrose Dermatology PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Penrose 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Penrose Dermatology PLLC was last updated on June 28, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.