Melissa Liebold, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

026336 Issued in NY

Practice address

1500 Route 112 Ste a
Port Jefferson Station, NY 11776-8055

Phone

(631) 265-4200

NPI assigned

Dec 20, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Harbor View Medical Services PCGroup PAC ID 5092865873, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

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.

• Harbor View Medical Services PC

  • Internal Medicine Physician
  • Port Jefferson, NY
  • NPI 1306631742
  Medicare reassignment Care Compare group NPD
• Harbor View Medical Services PC

  • Pulmonary Disease Physician
  • Port Jefferson, NY
  • NPI 1861636219
  Medicare reassignment NPD (past)
• Roberta a Bianco Dopc

  • Primary Care Clinic/Center
  • Smithtown, NY
  • NPI 1609032887
  Medicare reassignment
• Harbor View Medical Services PC

  • Gastroenterology Physician
  • Port Jefferson Station, NY
  • NPI 1871150193
  NPD

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

• John T. Mather Memorial Hospital

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1093718728
  Care Compare affiliation

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

{
    "created_epoch": "1608422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1235725672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 DORCHESTER RD",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117791616",
            "telephone_number": "631-338-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 STE A",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768055",
            "telephone_number": "631-265-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBOLD",
        "first_name": "MELISSA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-20",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Michael Levanti, RPH
• Susan A Levanti
• Jourdan T Levy Petrone
• Li Anxiety Care
• William J Li Pera, MD
• Maryana Liedke, DO
• Lifeskillsandpsychotherapy Services, PC
• Jody Lin, PHARMD/MBA
• Patricia Lin
• Sophia Vivian Lin, D.C.

• Physician Assistant in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.

Verify at the official NPI Registry.