Individual provider Active NPI

Elizabeth Domenica Dibartolo, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1194493148
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
027316 Issued in NY
Practice address
160 E 53Rd St
New York, NY 10022-5243
Phone
(212) 639-2000
NPI assigned
Sep 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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 027316 NY Primary
Physician Assistant 363A00000X NY

Addresses

Primary practice location

160 E 53Rd St
New York, NY 10022-5243

Mailing address

7521 Furmanville Ave
Middle Village, NY 11379-2221
Phone (347) 580-2660

Other practice location 1

622 W 168th St
New York, NY 10032-3720
Phone (877) 426-5637

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
I20260302000183 NY Practitioner - Physician Assistant 8123418167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Mercy College, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

633 3Rd Ave
New York, NY 10017-6700

633 3Rd Ave
New York, NY 10017-6706

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
027316NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Anesthesiology Group CurrentSince Jan 14, 2026 Accepting new patients

Organizations & group practices 1

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762992000000",
    "number": "1194493148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7521 FURMANVILLE AVE",
            "city": "MIDDLE VILLAGE",
            "state": "NY",
            "postal_code": "113792221",
            "telephone_number": "347-580-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E 53RD ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100225243",
            "telephone_number": "212-639-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323720",
            "country_code": "US",
            "telephone_number": "877-426-5637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIBARTOLO",
        "first_name": "ELIZABETH",
        "middle_name": "DOMENICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-03",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "027316",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.