PARK AVENUE DERMATOLOGY, PC
NPI 1730393042
Specialist in Staten Island, NY
About Park Avenue Dermatology, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PARK AVENUE DERMATOLOGY, PC (NPI 1730393042) is a healthcare organization registered as a specialist in Staten Island, New York and active in the NPI registry since May 2007. The organization lists Dominick Ligresti, Doctor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 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)
Park Avenue Dermatology, Pc 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 Park Avenue Dermatology, PC, 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 Park Avenue Dermatology, PC's NPI number?
The NPI number for Park Avenue Dermatology, PC is 1730393042. It was assigned to this organization in the NPPES registry on May 9, 2007.
Where is Park Avenue Dermatology, PC located?
Park Avenue Dermatology, PC is located at 31 Tioga St, Staten Island, NY 10301. The listed phone number is (718) 981-5040.
What is Park Avenue Dermatology, PC's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Park Avenue Dermatology, PC enrolled in Medicare?
Yes. Park Avenue Dermatology, PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Park Avenue Dermatology, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Park Avenue Dermatology, PC. 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 Park Avenue Dermatology, PC was last updated on February 2, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Park Avenue Dermatology, Pc · NPI 1730393042
Specialist organization in Staten Island, New York. Organization record, active in the CMS NPPES registry since May 9, 2007.
## Identity
- **NPI:** 1730393042 (Entity type: Organization)
- **Enumerated:** May 9, 2007
- **Primary specialty:** Specialist · taxonomy 174400000X
- **Organization subpart:** No
- **Authorized official:** Dominick Ligresti, DOCTOR
## Practice location
- **Address:** 31 TIOGA ST, Staten Island, NY 10301-4329
- **Phone:** (718) 981-5040
## 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:** February 2, 2017
- **Other identifiers:** Medicare ID-Type Unspecified WLQ241 (NY)
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Source: [NPI Profile](https://npiprofile.com/npi/1730393042) · Data from the CMS NPPES public registry.