Individual provider Active NPI

Inessa Natanov, PA

  • Medical Physician Assistant
  • Rego Park, NY
National Provider Identifier
1164690913
Registry record updated Feb 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
011968 Issued in NY
Practice address
9785 Queens Blvd
Rego Park, NY 11374-3319
Phone
(718) 261-9100
Fax
(718) 897-2915
NPI assigned
Feb 14, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 011968 NY Primary

Addresses

Primary practice location

9785 Queens Blvd
Rego Park, NY 11374-3319

Mailing address

9777 Queens Blvd
Rego Park, NY 11374-3335
Phone (718) 261-9100

Other identifiers 1

IdentifierTypeStateIssuer
011968OtherNYLICENSE

Other names 1

  • Mrs. Inessa Munarova Professional name

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
I20250217001538 NY Practitioner - Physician Assistant 3870023161 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
011968NYMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Jan 1, 2025 Accepting new patients
New York University CurrentSince Jan 1, 2025 Accepting new patients

Locations

700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325

9777 Queens Blvd
Rego Park, NY 11374
Phone (718) 275-9300

9785 Queens Blvd
Rego Park, NY 11374
Phone (631) 360-0266

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

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": "1202947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1164690913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9777 QUEENS BLVD",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743335",
            "telephone_number": "718-261-9100",
            "fax_number": "718-897-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9785 QUEENS BLVD",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743319",
            "telephone_number": "718-261-9100",
            "fax_number": "718-897-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NATANOV",
        "first_name": "INESSA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-14",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "011968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "011968",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "INESSA",
            "last_name": "MUNAROVA",
            "prefix": "MRS.",
            "credential": "PHYSICIAN ASSISTANT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Rego Park, NY

Sources for this page

Verify at the official NPI Registry.