Individual provider Active NPI

Jeffrey Calderon

  • Physician Assistant
  • Plainview, NY
National Provider Identifier
1073214383
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
700 Old Country Rd Ste 203
Plainview, NY 11803-4932
Phone
(516) 822-9730
NPI assigned
Mar 14, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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 Primary

Addresses

Primary practice location

700 Old Country Rd Ste 203
Plainview, NY 11803-4932

Mailing address

700 Old Country Rd
Plainview, NY 11803-4932

Other practice location 1

2000 N Village Ave Ste 301
Rockville Centre, NY 11570-1001
Phone (516) 822-9730

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
I20230608002559 NY Practitioner - Physician Assistant 9032576855 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Accurate Dermatology P.L.L.C. PastSince Oct 13, 2024 Accepting new patients

Organizations & group practices 2

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": "1678752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1073214383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 OLD COUNTRY RD",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118034932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OLD COUNTRY RD STE 203",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118034932",
            "telephone_number": "516-822-9730"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 N Village Ave Ste 301",
            "address_purpose": "LOCATION",
            "city": "Rockville Centre",
            "state": "NY",
            "postal_code": "115701001",
            "country_code": "US",
            "telephone_number": "516-822-9730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALDERON",
        "first_name": "JEFFREY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-14",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainview, NY

Sources for this page

Verify at the official NPI Registry.