Individual provider Active NPI

Peiman Ghatan

  • Physician Assistant
  • Cedarhurst, NY
National Provider Identifier
1003495045
Registry record updated Jul 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
026513 Issued in NY
Practice address
409 Central Ave Unit B
Cedarhurst, NY 11516-1920
Phone
(516) 453-4553
Fax
(516) 879-5081
NPI assigned
Apr 6, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 026513 NY Primary
Adult Medicine Physician 207QA0505X 026513 NY

Addresses

Primary practice location

409 Central Ave Unit B
Cedarhurst, NY 11516-1920

Mailing address

409 Central Ave Unit B
Cedarhurst, NY 11516-1920
Phone (516) 453-4553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241220002074 NY Practitioner - Physician Assistant 1456888080

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
026513NYMDAdult Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784419200000",
    "number": "1003495045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 CENTRAL AVE UNIT B",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115161920",
            "telephone_number": "516-453-4553",
            "fax_number": "516-879-5081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 CENTRAL AVE UNIT B",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115161920",
            "telephone_number": "516-453-4553",
            "fax_number": "516-879-5081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHATAN",
        "first_name": "PEIMAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-06",
        "last_updated": "2026-07-19",
        "certification_date": "2026-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026513",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NY",
            "license": "026513",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedarhurst, NY

Sources for this page

Verify at the official NPI Registry.