MEDICARE: CONNOLLY DERMATOLOGY FLORIDA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1124980487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNOLLY DERMATOLOGY FLORIDA LLC

Provider Business Mailing Address
First Line	:	2099 NEW ALBANY RD
Second Line	:
City	:	CINNAMINSON
State	:	NJ
Zip	:	08077-3534
Country	:	US
Telephone Number	:	609-926-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 LINCOLN RD
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3116
Country	:	US
Telephone Number	:	888-377-5177
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. VALERIE HILL
Credential	:
Telephone Number	:	609-926-8899

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	12/08/2025

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