Active NPI
Peter James Wynne, PA
- Physician Assistant
- Bellmore, NY
National Provider Identifier
1215111455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 006953
- Practice address
- 2154 Newbridge Rd
Bellmore, NY 11710-2239 - Phone
- (516) 221-0225
- Fax
- (516) 409-9766
- NPI assigned
- Dec 24, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 006953 | NY | Primary |
Addresses
Primary practice location
2154 Newbridge Rd
Bellmore, NY 11710-2239
Mailing address
2154 Newbridge Rd
Bellmore, NY 11710-2239
Phone (516) 221-0225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 069053 | NY | MD | Clinical Social Worker |
| 006953 | NY | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edison R. Blanco Physician PC | Past | 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.
-
- Family Medicine Physician
- Bay Shore, NY
- NPI 1669631032
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198454400000",
"number": "1215111455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2154 NEWBRIDGE RD",
"city": "BELLMORE",
"state": "NY",
"postal_code": "117102239",
"telephone_number": "516-221-0225",
"fax_number": "516-409-9766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2154 NEWBRIDGE RD",
"city": "BELLMORE",
"state": "NY",
"postal_code": "117102239",
"telephone_number": "516-221-0225",
"fax_number": "516-409-9766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNNE",
"first_name": "PETER",
"middle_name": "JAMES",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-24",
"last_updated": "2007-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "006953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellmore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.