NPIMap

Individual provider Active NPI

Marissa S Sydial, PA-C

  • Physician Assistant
  • Merrick, NY
National Provider Identifier
1336638063
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
022028 Issued in NY
Practice address
389 Merrick Ave
Merrick, NY 11566-2723
Phone
(516) 867-5132
NPI assigned
May 8, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 022028 NY Primary

Addresses

Primary practice location

389 Merrick Ave
Merrick, NY 11566-2723

Mailing address

281 1St Ave
New York, NY 10003-2925

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180718001735 NY Practitioner - Physician Assistant 6800143132 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians

Practice addresses (Care Compare)

13434 Springfield Blvd
Springfield Gardens, NY 11413-1459
Phone (516) 537-9063

377 S Oyster Bay Rd
Plainview, NY 11803-3323
Phone (516) 537-9061

5828 99TH St
Corona, NY 11368-4306
Phone (718) 502-9867

5828 99TH St Corona
Corona, NY 11368-4306
Phone (718) 502-9867

595 Hempstead Tpke
Suite a
West Hempstead, NY 11552-1030
Phone (347) 493-2952

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
022028NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Jun 17, 2019 Accepting new patients
New York University CurrentSince Jun 17, 2019 Accepting new patients
Fpa Hospital Based CurrentSince Oct 22, 2018 Accepting new patients
North Shore - Lij Medical PC CurrentSince Oct 1, 2019 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 1, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 1, 2023 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

5 E 98th St
New York, NY 10029
Phone (212) 241-3986

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

281 1st Ave
New York, NY 10003
Phone (212) 844-1808

300 Community Dr
Plandome, NY 11030

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: msydial307516@nyumc.direct-ci.com
  • Direct secure messaging: marissa.sydial@ghuc.eclinicaldirectplus.com

Organizations & group practices 10

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1336638063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100032925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "389 MERRICK AVE",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115662723",
            "telephone_number": "516-867-5132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYDIAL",
        "first_name": "MARISSA",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-08",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrick, NY

Sources for this page

Verify at the official NPI Registry.