Individual provider Active NPI

Maxine I Pascal, PA-C

  • Physician Assistant
  • Carmel, NY
National Provider Identifier
1356064380
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
686 Stoneleigh Ave
Carmel, NY 10512-3931
Phone
(845) 279-2952
NPI assigned
Sep 23, 2022
Last updated
Nov 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 028966 NY
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

686 Stoneleigh Ave
Carmel, NY 10512-3931

Mailing address

51 Forest Ave Apt 157
Old Greenwich, CT 06870-1534

Other practice location 1

75 Veronica Ave Ste 205
Somerset, NJ 08873-5002
Phone (732) 246-9900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20221027002610 NY Practitioner - Physician Assistant 7012384456 Reassigns benefits to 1 organization
I20241214000134 NJ Practitioner - Physician Assistant 7012384456 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aura Dermatology at Edison LLCGroup PAC ID 1355784646, 4 clinicians
Aura Dermatology at Somerset LLCGroup PAC ID 0648606087, 5 clinicians

Practice addresses (Care Compare)

659 New Dover Rd
Edison, NJ 08820-1912
Phone (732) 912-7909

75 Veronica Ave
Suite 205
Somerset, NJ 08873-5002
Phone (732) 246-9900

National Provider Directory

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1356064380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 FOREST AVE APT 157",
            "city": "OLD GREENWICH",
            "state": "CT",
            "postal_code": "068701534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "686 STONELEIGH AVE",
            "city": "CARMEL",
            "state": "NY",
            "postal_code": "105123931",
            "telephone_number": "845-279-2952"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Veronica Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Somerset",
            "state": "NJ",
            "postal_code": "088735002",
            "country_code": "US",
            "telephone_number": "732-246-9900",
            "fax_number": "732-246-9903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASCAL",
        "first_name": "MAXINE",
        "middle_name": "I",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-23",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "028966",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, NY

Sources for this page

Verify at the official NPI Registry.