Gennadiy Shamalov, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

008219-1 Issued in NY

Practice address

141-23 Hoover Ave
Briarwood, NY 11435-1604

Phone

(917) 709-4733

NPI assigned

Jan 3, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

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.

• Flushing Hospital & Medical Center

  • General Acute Care Hospital
  • Flushing, NY
  • NPI 1548217763
  Medicare reassignment
• Registered Physician Assistant First Assist PC

  • Surgical Physician Assistant
  • Briarwood, NY
  • NPI 1164753182
  NPD (past) Authorized official
• Flushing Hospital Medical Center

  • Skilled Nursing Facility
  • Flushing, NY
  • NPI 1568693174
  NPD
• CMC Radiological Services PC

  • Diagnostic Radiology Physician
  • Elmhurst, NY
  • NPI 1093851990
  NPD (past)
• CMC Radiological Services PC

  • Diagnostic Radiology Physician
  • Jamaica, NY
  • NPI 1285780502
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1174670319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141-23 HOOVER AVE",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "114352930",
            "telephone_number": "917-709-4733",
            "fax_number": "718-559-4895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141-23 HOOVER AVE",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "114351604",
            "telephone_number": "917-709-4733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMALOV",
        "first_name": "GENNADIY",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "008219-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam M Schutz
• Bisma Tahir Sekhery, PHARMD
• Maryam Tahir Sekhery, PHARMD
• Rachel Seubert, M.S. CCC-SLP
• Natalya Shakarov
• Heather Shannon
• Shormin Shariff
• Sharon Shaulov, OTR/L
• Mikayla Gabrielle Sherman, RN
• Silvercrest

• Surgical Physician Assistant in Briarwood, NY
• Providers in Briarwood, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; 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.