Etk Rpa, PC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

001662 Issued in NY

Legal business name

ETK RPA, PC

Practice address

19 Fox Trail Court
Aquebogue, NY 11931-0083

Phone

(631) 766-6538

NPI assigned

May 25, 2006

Organization subpart

No

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

Authorized official

Name

Eugene T King

Title

President

Phone

(631) 766-6538

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265488027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 83",
            "city": "AQUEBOGUE",
            "state": "NY",
            "postal_code": "119310083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 FOX TRAIL COURT",
            "city": "AQUEBOGUE",
            "state": "NY",
            "postal_code": "119310083",
            "telephone_number": "631-766-6538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETK RPA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-766-6538"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "001662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Coast Medical Wellness, PLLC
• Caritas Residence
• Dawn Carrera, RN
• Chrystal Lee Curran
• Lisa A Dandrea, SLP
• Nadine M. Grothmann, R.N., A.N.P.
• Hamid Javidi, MD
• Jacqueline E King-Presant, MA ED.
• Ellen C Knieriemen
• Lois M. Leonard, SLP

• Surgical Physician Assistant in Aquebogue, NY
• Providers in Aquebogue, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.