Marilyn Koppschall
Individual provider Active NPI Physician Assistant · Rifton, NY
NPI 1013614239 · NPPES record last updated Jan 5, 2026
Key facts
- NPI
- 1013614239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 033050 (NY)
- Practice address
- 105 Woodcrest Dr
Rifton, NY 12471-7200 - Phone
- (724) 880-3626
- NPI assigned
- Feb 8, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Esopus Medical, PC
Practice addresses (Care Compare)
10 Hellbrook Lane
Ulster Park, NY 12487-5209
10 Hellbrook LN
Ulster Park, NY 12487-5209
Phone (845) 658-7763
Hospital & facility affiliations
- Northern Dutchess Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250210002213 | NY | Practitioner - Physician Assistant | 7012447857 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033050 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Esopus Dental, PC | Past |
Accepting new patients |
Interoperability endpoints
- marilyn.keiderling@931273876307972.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 033050 | NY | Yes |
Addresses
Primary practice location
105 Woodcrest Dr
Rifton, NY 12471-7200
Mailing address
105 Woodcrest Dr
Rifton, NY 12471-7200
Phone (724) 880-3626
Other providers in Rifton, NY
- Esopus Dental, PC
- Esopus Medical, PC
- Celina Goodwin
- Maria N Huleatt
- Katherine Joy Keiderling
- Alison Ann Maendel
- Monika R. a. Mommsen
- Occupational Therapy of Rifton
- Florence M. J. Potts
- Patricia R Rice
All providers in Rifton, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.