Active NPI
Phyllis Altadonna, RPA-C
- Physician Assistant
- New York, NY
National Provider Identifier
1104961713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 009880-1
- Practice address
- 5141 Broadway
New York, NY 10034-1159 - Phone
- (212) 932-5218
- NPI assigned
- Feb 21, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 009880-1 | NY | Primary |
Addresses
Primary practice location
5141 Broadway
New York, NY 10034-1159
Mailing address
1055 River Rd
Apt 802
Edgewater, NJ 07020-1364
Phone (212) 932-5218
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009880-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104961713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 RIVER RD",
"address_2": "APT 802",
"city": "EDGEWATER",
"state": "NJ",
"postal_code": "070201364",
"telephone_number": "212-932-5218",
"fax_number": "212-932-5258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5141 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100341159",
"telephone_number": "212-932-5218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALTADONNA",
"first_name": "PHYLLIS",
"name_prefix": "Ms.",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "009880-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.