Active NPI
Rebeca Wine, PA
- Physician Assistant
- New York, NY
National Provider Identifier
1174388680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 535 W 110TH St Apt 1E
New York, NY 10025-2021 - Phone
- (212) 280-4740
- NPI assigned
- Feb 14, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | NY | Primary |
Addresses
Primary practice location
535 W 110TH St Apt 1E
New York, NY 10025-2021
Mailing address
968 E Lawn Dr
Teaneck, NJ 07666-6641
Phone (914) 318-5931
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
535 W 110TH St
Apt 1E
New York, NY 10025-2021
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Chiropractic Enterprise PLLC | Past | Accepting new patients | |
| Practice Associates Medical Group | Family Medicine | Past | Accepting new patients |
| Crystal Run Medical Services PC | Past | Accepting new patients |
Organizations & group practices 4
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.
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-
- Internal Medicine Physician
- Middletown, NY
- NPI 1104921139
-
- Internal Medicine Physician
- Morristown, NJ
- NPI 1427016385
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755734400000",
"number": "1174388680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "968 E LAWN DR",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076666641",
"telephone_number": "914-318-5931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 W 110TH ST APT 1E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100252021",
"telephone_number": "212-280-4740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WINE",
"first_name": "REBECA",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-14",
"last_updated": "2025-08-21",
"certification_date": "2025-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": null,
"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 Aug 21, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.