Healthcare Provider Details

I. General information

NPI: 1124980487
Provider Name (Legal Business Name): CONNOLLY DERMATOLOGY FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LINCOLN RD
MIAMI BEACH FL
33139-3116
US

IV. Provider business mailing address

2099 NEW ALBANY RD
CINNAMINSON NJ
08077-3534
US

V. Phone/Fax

Practice location:
  • Phone: 888-377-5177
  • Fax:
Mailing address:
  • Phone: 609-926-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. VALERIE HILL
Title or Position: BILLING MANAGER
Credential:
Phone: 609-926-8899