Jessica Marie Donofrio, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

018211 Issued in NY

Practice address

1050 Old Nichols Rd
Islandia, NY 11749-5026

Phone

(631) 828-4545

NPI assigned

Oct 24, 2014

Last updated

Nov 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Community Medical Wellness PC

  • Pain Medicine Physician
  • Port Jefferson Station, NY
  • NPI 1073002473
  Medicare reassignment
• Emergency Medicine Physicians of Suffolk County, PLLC

  • Emergency Medicine Physician
  • East Patchogue, NY
  • NPI 1669783924
  NPD (past)

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1326443029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 PATRICIA LN",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552843",
            "telephone_number": "631-375-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 OLD NICHOLS RD",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495026",
            "telephone_number": "631-828-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONOFRIO",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-24",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "018211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pia Patricia Bosita De Guzman
• Alison De Los Santos
• Benjamin Defieux, LMSW
• Teresa Desantis
• Amy Donnolo, LMHC
• Amanda Donovan
• Laura A. Doti, N.P.
• Frank G Dowling, M.D.
• Mary Kathryn Doyle, M.A., CCC-A
• Charles Druiett Jr., RPH

• Medical Physician Assistant in Islandia, NY
• Providers in Islandia, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; 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.

Verify at the official NPI Registry.