Individual provider Active NPI

Dibnain Nanda

  • Surgical Physician Assistant
  • Middletown, NY
National Provider Identifier
1144647959
Registry record updated Oct 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
017478 Issued in NY
Practice address
707 E Main St
Middletown, NY 10940-2650
Phone
(845) 333-7575
Fax
(845) 333-7201
NPI assigned
Mar 19, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2017

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 017478 NY
Surgical Physician Assistant 363AS0400X 017478 NY Primary

Addresses

Primary practice location

707 E Main St
Middletown, NY 10940-2650

Mailing address

707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-1114

Other practice location 1

155 Crystal Run Rd
Middletown, NY 10941-4028
Phone (845) 703-6999

Other identifiers 1

IdentifierTypeStateIssuer
03876208MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509062400000",
    "number": "1144647959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-1114",
            "fax_number": "845-333-2645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-7575",
            "fax_number": "845-333-7201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Crystal Run Rd",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "NY",
            "postal_code": "109414028",
            "country_code": "US",
            "telephone_number": "845-703-6999",
            "fax_number": "845-703-6297",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NANDA",
        "first_name": "DIBNAIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-19",
        "last_updated": "2017-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "017478",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "017478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03876208",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.