Active NPI
Kristina Theresa Dimezza, PHYSICIAN ASSISTANT
- Physician Assistant
- Smithtown, NY
National Provider Identifier
1306210216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 50 Ny 25-a
Smithtown, NY 11787-4916 - Phone
- (631) 862-3000
- NPI assigned
- Nov 17, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 019235 | NY | |
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
50 Ny 25-a
Smithtown, NY 11787-4916
Mailing address
225 Eastview Dr
Central Islip, NY 11722-4539
Phone (631) 665-1600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04354629 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019235 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637193600000",
"number": "1306210216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 EASTVIEW DR",
"city": "CENTRAL ISLIP",
"state": "NY",
"postal_code": "117224539",
"telephone_number": "631-665-1600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 NY 25-A",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117874916",
"telephone_number": "631-862-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIMEZZA",
"first_name": "KRISTINA",
"middle_name": "THERESA",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-17",
"last_updated": "2021-11-18",
"certification_date": "2021-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NY",
"license": "019235",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04354629",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Smithtown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.