Individual provider Active NPI

Mark Grzesiak, RPAC

  • Physician Assistant
  • Mineola, NY
National Provider Identifier
1376717272
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
010785 Issued in NY
Practice address
259 1St St
Mineola, NY 11501-3957
Phone
(516) 663-8312
Fax
(516) 663-2184
NPI assigned
Apr 22, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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 010785 NY Primary

Addresses

Primary practice location

259 1St St
Mineola, NY 11501-3957

Mailing address

700 Hicksville Rd
Suite 204
Bethpage, NY 11714-3471
Phone (516) 576-6106

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100720000770 NY Practitioner - Physician Assistant 9436281888 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

440 E Main St
Bay Shore, NY 11706-8501

450 Lakeville Rd
New Hyde Park, NY 11042-1118
Phone (516) 734-8900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.07 of 100Reported as group
Quality
57.91
Promoting interoperability
77
Improvement activities
40
Cost
80.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
010785NYMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Sep 17, 2018 Accepting new patients
Sunil H. Butani Physician P.C. CurrentSince Jan 23, 2017 Accepting new patients

Locations

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

440 E Main St
Bay Shore, NY 11706
Phone (631) 414-2023

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

270 Pulaski Rd
Ste C
Greenlawn, NY 11740

259 1st St
Mineola, NY 11501
Phone (516) 576-1820

184 Old Country Rd
Mineola, NY 11501
Phone (516) 294-4457

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

450 Lakeville Rd
North New Hyde Park, NY 11042
Phone (516) 321-3000

27005 76th Ave
North New Hyde Pk, NY 11040

300 Community Dr
Plandome, NY 11030

9525 Queens Blvd
Ste B
Rego Park, NY 11374
Phone (718) 925-6200

Networks

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

Organizations & group practices 5

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 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": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1376717272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 HICKSVILLE RD",
            "address_2": "SUITE 204",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117143471",
            "telephone_number": "516-576-6106",
            "fax_number": "516-576-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-663-8312",
            "fax_number": "516-663-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRZESIAK",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "RPAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.