Individual provider Active NPI

Pessie Kronglas, PA

  • Physician Assistant
  • Lakewood, NJ
National Provider Identifier
1053675520
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00277400 Issued in NJ
Practice address
1771 Madison Ave
Lakewood, NJ 08701-1251
Phone
(732) 364-2144
Fax
(732) 364-3559
NPI assigned
Jun 29, 2012
Last updated
Jun 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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 25MP00277400 NJ Primary
Medical Physician Assistant 363AM0700X 25MP00277400 NJ

Addresses

Primary practice location

1771 Madison Ave
Lakewood, NJ 08701-1251

Mailing address

1771 Madison Ave
Lakewood, NJ 08701-1251
Phone (732) 364-2144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20131107000555 NJ Practitioner - Physician Assistant 2062647639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1771 Madison Ave
Lakewood, NJ 08701-1242
Phone (732) 364-2144

1771 Madison Ave
Lakewood, NJ 08701-1251

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakewood Resource and Referral Center, Inc. CurrentSince Oct 2, 2013 Accepting new patients
Lakewood Resource and Referral Center Inc CurrentSince Oct 2, 2013 Accepting new patients
Lakewood Resource and Referral Center Inc Past Accepting new patients

Locations

1771 Madison Ave
Lakewood, NJ 08701
Phone (732) 364-2144

Interoperability endpoints

  • Direct secure messaging: pessie.kronglas@chemed.eclinicaldirectplus.com

Organizations & group practices 3

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1053675520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011251",
            "telephone_number": "732-364-2144",
            "fax_number": "732-364-3559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011251",
            "telephone_number": "732-364-2144",
            "fax_number": "732-364-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRONGLAS",
        "first_name": "PESSIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-29",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00277400",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00277400",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.