Maksim Nisenboym, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

015471 Issued in NY

Practice address

14755 Hoover Ave
Briarwood, NY 11435-2139

Phone

(718) 523-5674

NPI assigned

Feb 10, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: man9104@direct.nyp.org

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.

• Community Assistance Resources & Extended Services Inc

  • Case Management Agency
  • New York, NY
  • NPI 1396049987
  Medicare reassignment

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

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328832000000",
    "number": "1063785863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14755 HOOVER AVE",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "114352139",
            "telephone_number": "718-523-5674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14755 HOOVER AVE",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "114352139",
            "telephone_number": "718-523-5674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISENBOYM",
        "first_name": "MAKSIM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-10",
        "last_updated": "2012-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latchmi D Nagaswar, NP-C
• Tiffany Narain, PSYD
• Daniel Natanov, NP
• Larisa Natanov, PHARM.D.
• Shanna Nichols, LCSW
• Bella Niyazova
• Northeast Services 5 Inc
• Michael Notkin
• Nneoma Akwarandu Nwuzor, NYS RN
• Ny Therapy for Kids, Inc.

• Physician Assistant in Briarwood, NY
• Providers in Briarwood, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.