Individual provider Active NPI

Marina Vaysman, PA

  • Physician Assistant
  • Far Rockaway, NY
National Provider Identifier
1033440904
Registry record updated Jan 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
007911 Issued in NY
Practice address
493 Beach 20TH St
Far Rockaway, NY 11691-3621
Phone
(718) 327-6400
Fax
(718) 327-2218
NPI assigned
Jan 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 007911 NY Primary

Addresses

Primary practice location

493 Beach 20TH St
Far Rockaway, NY 11691-3621

Mailing address

204 Combs Ave
Woodmere, NY 11598-1456
Phone (516) 695-4747

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
I20190703000310 NY Practitioner - Physician Assistant 5193059640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Cutting Edge Medical P.C.Group PAC ID 6002872264, 2 clinicians

Practice addresses (Care Compare)

493 Beach 20TH St
Far Rockaway, NY 11691-3621
Phone (718) 327-6400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
007911NYMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1263600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263600000000",
    "number": "1033440904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 COMBS AVE",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115981456",
            "telephone_number": "516-695-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 BEACH 20TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913621",
            "telephone_number": "718-327-6400",
            "fax_number": "718-327-2218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAYSMAN",
        "first_name": "MARINA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-16",
        "last_updated": "2010-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "007911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Far Rockaway, NY

Sources for this page

Verify at the official NPI Registry.