Active NPI
Agathae Grace Benetatos, RPAC
- Medical Physician Assistant
- Staten Island, NY
National Provider Identifier
1043496763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 004994
- Practice address
- 410 Maryland Ave
3D
Staten Island, NY 10305-2973 - Phone
- (718) 816-5601
- NPI assigned
- Jan 11, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 004994 | NY | Primary |
Addresses
Primary practice location
410 Maryland Ave
3D
Staten Island, NY 10305-2973
Mailing address
410 Maryland Ave
3D
Staten Island, NY 10305-2973
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004994 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200009600000",
"number": "1043496763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 MARYLAND AVE",
"address_2": "3D",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103052973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 MARYLAND AVE",
"address_2": "3D",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103052973",
"telephone_number": "718-816-5601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENETATOS",
"first_name": "AGATHAE",
"middle_name": "GRACE",
"name_prefix": "Ms.",
"credential": "RPAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-11",
"last_updated": "2008-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "004994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.