Individual provider Active NPI

Edward A Wansor, PA-C

  • Physician Assistant
  • Calverton, NY
National Provider Identifier
1346595923
Registry record updated Jul 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
29 Pheasant LN
Calverton, NY 11933-1326
Phone
(631) 338-3282
NPI assigned
Jul 19, 2012
Last updated
Jul 19, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2012

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 Primary

Addresses

Primary practice location

29 Pheasant LN
Calverton, NY 11933-1326

Mailing address

29 Pheasant LN
Calverton, NY 11933-1326
Phone (631) 338-3282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, OH, VA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20131231000015 NY Practitioner - Physician Assistant 3779710454 Reassigns benefits to 2 organizations
I20250421002231 OH Practitioner - Physician Assistant 3779710454 Reassigns benefits to 1 organization
I20250422002396 VA Practitioner - Physician Assistant 3779710454 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

101 Saint Andrews LN
Glen Cove, NY 11542-2254
Phone (631) 675-4550

300 Community Dr
Manhasset, NY 11030-3816

300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229

330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550

350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
016772NYMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Mar 2, 2025 Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

101 Saint Andrews Ln
Glen Cove, NY 11542
Phone (516) 674-7300

270 Park Ave
Huntington, NY 11743
Phone (631) 351-2308

300 Community Dr
Manhasset, NY 11030

888 Old Country Rd
Plainview, NY 11803
Phone (516) 719-2543

1 Heroes Way
Riverhead, NY 11901
Phone (631) 548-6000

701 N Broadway
Sleepy Hollow, NY 10591
Phone (914) 366-3140

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

221 Jericho Tpke
Syosset, NY 11791
Phone (516) 496-6400

900 Franklin Ave
Valley Stream, NY 11580
Phone (516) 256-6000

Networks

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

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1346595923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 PHEASANT LN",
            "city": "CALVERTON",
            "state": "NY",
            "postal_code": "119331326",
            "telephone_number": "631-338-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 PHEASANT LN",
            "city": "CALVERTON",
            "state": "NY",
            "postal_code": "119331326",
            "telephone_number": "631-338-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANSOR",
        "first_name": "EDWARD",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-19",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calverton, NY

Sources for this page

Verify at the official NPI Registry.