GLAMDERM
NPI 1720485808
Specialist in New York, NY
About Glamderm NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GLAMDERM (NPI 1720485808) is a healthcare organization registered as a specialist in New York, New York and active in the NPI registry since December 2014. The organization lists Lian A Mack, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Glamderm 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 Glamderm, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Mack Dermatology, P.C.'s NPI number?
The NPI number for Mack Dermatology, P.C. is 1720485808. It was assigned to this organization in the NPPES registry on December 4, 2014. The provider is doing business as Glamderm.
Where is Mack Dermatology, P.C. located?
Mack Dermatology, P.C. is located at 130 E 18th St Suite 1U, New York, NY 10003. The listed phone number is (917) 912-3615.
What is Mack Dermatology, P.C.'s specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Mack Dermatology, P.C. enrolled in Medicare?
Yes. Mack Dermatology, P.C. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Mack Dermatology, P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Mack Dermatology, P.C.. 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 Mack Dermatology, P.C. was last updated on December 4, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Glamderm · NPI 1720485808
Specialist organization in New York, New York. Organization record, active in the CMS NPPES registry since December 4, 2014.
## Identity
- **NPI:** 1720485808 (Entity type: Organization)
- **Enumerated:** December 4, 2014
- **Primary specialty:** Specialist · taxonomy 174400000X
- **Legal business name:** Mack Dermatology, P.c.
- **Organization subpart:** No
- **Authorized official:** Lian Mack, OWNER
## Practice location
- **Address:** 130 E 18TH ST, SUITE 1U, New York, NY 10003-2416
- **Phone:** (917) 912-3615
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Dermatology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 4, 2014
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Source: [NPI Profile](https://npiprofile.com/npi/1720485808) · Data from the CMS NPPES public registry.