Healthcare Provider Details

I. General information

NPI: 1457728883
Provider Name (Legal Business Name): INTEGRATED DERMATOLOGY OF CLINTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 BOSTON POST RD APT 101
MADISON CT
06443-3481
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-6156
  • Fax: 860-664-0285
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM S PLOTKIN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 561-314-2000