ADVANCED DERMATOLOGY CENTER, PC — NPI 1639160294 (Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) in WOLCOTT, CT)

CMS-1500 Box 24J / 33a • NPI

1639160294

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207N00000X (CMS 07)

Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)

Box 32 Service Location & ZIP+4

464 WOLCOTT RD, WOLCOTT, CT, 06716-2626

✓ 9-Digit EDI 837 ZIP+4 (06716-2626)

Practice Phone & Referral Fax

(203) 879-6171

Fax: (203) 879-1191

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1639160294 (ADVANCED DERMATOLOGY CENTER, PC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1639160294` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED DERMATOLOGY CENTER, PC
Plain-English Specialty	Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) NUCC Code: `207N00000X` (Dermatology)
Certifying / Licensing Body	American Board of Dermatology (ABD)
Practice Location Address	464 WOLCOTT RD, WOLCOTT, CT, 06716-2626
Practice Telephone / Fax	Tel: (203) 879-6171 \| Fax: (203) 879-1191
Administrative Mailing Address	464 WOLCOTT RD, WOLCOTT, CT, 06716-2626
Enumeration & Last Sync	Enumerated: 2005-11-02 \| CMS Record Updated: 2026-08-17
Authorized Official	RONALD JURZYK (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

464 WOLCOTT RD, WOLCOTT, CT, 06716-2626

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Plain-English Taxonomy & CMS Crosswalk (207N00000X)

What Does Taxonomy Code 207N00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207N00000X translates to:
"Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 07 (Physician/Dermatology)
Certifying / Accrediting Authority: American Board of Dermatology (ABD)
Clinical Scope: Changing moles, skin rashes, severe acne, eczema, psoriasis, fungal infections, hair loss, or skin cancer checks.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED DERMATOLOGY CENTER, PC)

Typical CPT / Diagnostic Procedures:

Full-Body Dermoscopy & Skin Cancer Screening
Shave, Punch & Excisional Skin Biopsy (CPT 11102–11107)
Cryotherapy Destruction of Actinic Keratoses & Viral Warts (CPT 17000)

Common Therapeutic Classes:

Topical Corticosteroids (Triamcinolone, Clobetasol) & Calcineurin Inhibitors
Topical & Oral Retinoids (Tretinoin, Adapalene, Isotretinoin)
Doxycycline, Minocycline & Antifungals (Terbinafine, Ketoconazole)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207N00000X` — Dermatology Plain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)	State: CT \| License: `035267` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ADVANCED DERMATOLOGY CENTER, PC (NPI #1639160294)