RADIANT SKIN DERMATOLOGY AND LASER,PLLC
NPI 1861738460
Dermatology in New York, NY

Active since December 31, 2012
207 W 115TH ST LOWR LEVEL, NEW YORK, NY 10026(212) 229-0007(347) 274-8349 Get Directions Write a Review

NPPES record last updated: March 4, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Radiant Skin Dermatology And Laser,pllc NPPES

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

RADIANT SKIN DERMATOLOGY AND LASER,PLLC (NPI 1861738460) is a healthcare organization registered as a dermatology in New York, New York and active in the NPI registry since December 2012. The organization lists Adebola Olufunmi Dele-michael, Owner, as its authorized official.

NPPES Registry Identity

NPI1861738460
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameRADIANT SKIN DERMATOLOGY AND LASER,PLLC
Location Address207 W 115TH ST LOWR LEVELNew York, NY 10026-2965
Mailing Address234 Central Park WNew York, NY 10024-6003 · (212) 229-0007 · Fax (212) 202-6350
Fax(347) 274-8349
Organization SubpartNo
Authorized OfficialAdebola Olufunmi Dele-michaelOwner · (212) 229-0007
Enumeration DateDecember 31, 2012
Last NPPES UpdateMarch 4, 2024
NPPES CertifiedMarch 4, 2024
✔ NPI 1861738460 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in NY · 256265
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.
207 W 115TH ST LOWR LEVEL, New York, NY 10026

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)

Radiant Skin Dermatology And Laser,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 Radiant Skin Dermatology And Laser,pllc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1235250820
116 CENTRAL PARK S STE 7
New York, NY 10019
(212) 229-0007
✔ PECOS✔ Accepts Medicare2.8 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 Radiant Skin Dermatology And Laser,pllc's NPI number?

The NPI number for Radiant Skin Dermatology And Laser,pllc is 1861738460. It was assigned to this organization in the NPPES registry on December 31, 2012.

Where is Radiant Skin Dermatology And Laser,pllc located?

Radiant Skin Dermatology And Laser,pllc is located at 207 W 115th St Lowr Level, New York, NY 10026. The listed phone number is (212) 229-0007.

What is Radiant Skin Dermatology And Laser,pllc's specialty?

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

Is Radiant Skin Dermatology And Laser,pllc enrolled in Medicare?

Yes. Radiant Skin Dermatology And Laser,pllc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Radiant Skin Dermatology And Laser,pllc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Radiant Skin Dermatology And Laser,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 Radiant Skin Dermatology And Laser,pllc was last updated on March 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.