Active NPI
Aiden Vanwagenen
- Physician Assistant
- Glens Falls, NY
National Provider Identifier
1235920323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 033944
- Practice address
- 102 Park Street
CR Wood Cancer Center
Glens Falls, NY 12801-4403 - Phone
- (518) 926-6620
- Fax
- (518) 926-6626
- NPI assigned
- May 16, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 033944 | NY | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
102 Park Street
CR Wood Cancer Center
Glens Falls, NY 12801-4403
Mailing address
100 Park Street
Glens Falls Hospital - Credentialing
Glens Falls, NY 12801-4413
Phone (518) 926-6992
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
102 Park St
Glens Falls, NY 12801-4403
Phone (518) 926-3326
79 N St
Granville Medical Center
Granville, NY 12832-1137
Phone (518) 642-0612
Hospital & facility affiliations
- Glens Falls Hospital
- Saratoga Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033944 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glens Falls Hospital Inc | Current | Accepting new patients |
Locations
102 Park St
Glens Falls, NY 12801
Phone (518) 793-5601
100 Park St
Glens Falls, NY 12801
Phone (518) 926-5924
79 North St
Granville, NY 12832
Phone (518) 642-0612
Organizations & group practices 2
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
- Glens Falls, NY
- NPI 1336198217
-
- Community/Retail Pharmacy
- Glens Falls, NY
- NPI 1619990991
Hospital & facility affiliations 19
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Glens Falls, NY
- NPI 1871606764
-
- Endocrinology, Diabetes & Metabolism Physician
- Gansevoort, NY
- NPI 1033371166
Hospital
-
- General Acute Care Hospital
- Saratoga Springs, NY
- NPI 1073569331
-
- General Acute Care Hospital
- Saratoga Springs, NY
- NPI 1093078560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754438400000",
"number": "1235920323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 PARK STREET",
"address_2": "GLENS FALLS HOSPITAL - CREDENTIALING",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128014413",
"telephone_number": "518-926-6992",
"fax_number": "518-926-6983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 PARK STREET",
"address_2": "CR WOOD CANCER CENTER",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128014403",
"telephone_number": "518-926-6620",
"fax_number": "518-926-6626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANWAGENEN",
"first_name": "AIDEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-05-16",
"last_updated": "2025-08-06",
"certification_date": "2025-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "033944",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glens Falls, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.