Maria Korogodsky, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00067500 Issued in NJ

Practice address

65 Bergen St
Newark, NJ 07107-3001

Phone

(973) 972-5686

NPI assigned

Sep 23, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Iconic Medical and Wellness Centers

  • Health Service Clinic/Center
  • Mendham, NJ
  • NPI 1831789338
  NPD Authorized official
• Practice Associates Medical Group

  • Internal Medicine Physician
  • Morristown, NJ
  • NPI 1427016385

  NJ

  Medicare reassignment
• Robert Wood Johnson Medical Associates

  • Hospitalist Physician
  • New Brunswick, NJ
  • NPI 1902848625

  NJ

  Medicare reassignment
• Rutgers Health-RWJ Neurosurgery Faculty

  • Urology Physician
  • New Brunswick, NJ
  • NPI 1710012604

  NJ

  Medicare reassignment
• Umdnj

  • General Acute Care Hospital
  • Warren, NJ
  • NPI 1316157514
  NPD (past) Authorized official
• Rutgers Health-RWJ Neurosurgery Faculty

  • Surgery Physician
  • New Brunswick, NJ
  • NPI 1083738637
  NPD
• Rutgers Health-RWJ Neurosurgery Faculty

  • Durable Medical Equipment & Medical Supplies
  • Neptune, NJ
  • NPI 1861290744
  NPD
• Rutgers Health-RWJ Neurosurgery Faculty

  • Pediatric Surgery Physician
  • New Brunswick, NJ
  • NPI 1487736146
  NPD (past)
• Trustees of Columbia University in the City of New York

  • Transplant Surgery Physician
  • New York, NY
  • NPI 1790739217

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1114177441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 SOFTWOOD WAY",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070596791",
            "telephone_number": "973-972-5686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 BERGEN ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071073001",
            "telephone_number": "973-972-5686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Old Short Hills Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "West Orange",
            "state": "NJ",
            "postal_code": "070521023",
            "country_code": "US",
            "telephone_number": "973-731-4600",
            "fax_number": "973-731-1477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Morristown",
            "state": "NJ",
            "postal_code": "079606136",
            "country_code": "US",
            "telephone_number": "973-971-4287",
            "fax_number": "973-290-8325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOROGODSKY",
        "first_name": "MARIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-23",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00067500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GASTROENTEROLOGY",
            "identifier": "25MP00067500",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yini Kong
• Yu Kong, MD
• Konicy Corp
• Anna Korban, M.D.
• Jeffrey Michael Kornitzer, M.D.
• Jooly P Koshy, APN
• Ranie Koshy, M.D.
• Christine Kosmides
• Sharwani Kota, MD
• Neil Kothari, M.D.

• All providers in Newark, NJ
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.