Active NPI
Griselle Villar Ledesma
- Medical Physician Assistant
- Corona, NY
National Provider Identifier
1255710240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 018582-1
- Practice address
- 10427 Corona Ave
Corona, NY 11368-2979 - Phone
- (718) 592-3458
- NPI assigned
- May 22, 2015
- Last updated
- Sep 29, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 018582-1 | NY | Primary |
Addresses
Primary practice location
10427 Corona Ave
Corona, NY 11368-2979
Mailing address
104-27 Corona Ave
Corona, NY 11368
Phone (718) 592-3458
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018582-1 | NY | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Health | Past | Accepting new patients | |
| New York City Health and Hospitals Corporation | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1679587679
-
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- Bellerose, NY
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443484800000",
"number": "1255710240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104-27 CORONA AVE",
"city": "CORONA",
"state": "NY",
"postal_code": "11368",
"telephone_number": "718-592-3458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10427 CORONA AVE",
"city": "CORONA",
"state": "NY",
"postal_code": "113682979",
"telephone_number": "718-592-3458"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLAR LEDESMA",
"first_name": "GRISELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-22",
"last_updated": "2015-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "018582-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; 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.