Individual provider Active NPI

Giancarlo David Cortez, PA

  • Physician Assistant
  • Jersey City, NJ
National Provider Identifier
1457035362
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00774900 Issued in NJ
Practice address
550 Newark Ave Ste 307
Jersey City, NJ 07306-1353
Phone
(201) 418-9111
NPI assigned
Jun 12, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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 25MP00774900 NJ Primary

Addresses

Primary practice location

550 Newark Ave Ste 307
Jersey City, NJ 07306-1353

Mailing address

247 Elm St
Elmwood Park, NJ 07407-1544
Phone (201) 824-3310

Other practice location 1

3916 Kennedy Blvd
Union City, NJ 07087-7887
Phone (201) 624-1877

Other practice location 2

433 60th St Fl 1
West New York, NJ 07093-2211
Phone (201) 770-9995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20231109003462 NJ Practitioner - Physician Assistant 7810344058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Garden State Cardiology LLCGroup PAC ID 3375675036, 15 clinicians

Practice addresses (Care Compare)

550 Newark Ave
Suite 307
Jersey City, NJ 07306-1353
Phone (201) 418-9111

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00774900NJMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1457035362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 ELM ST",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074071544",
            "telephone_number": "201-824-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 NEWARK AVE STE 307",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073061353",
            "telephone_number": "201-418-9111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3916 Kennedy Blvd",
            "address_purpose": "LOCATION",
            "city": "Union City",
            "state": "NJ",
            "postal_code": "070877887",
            "country_code": "US",
            "telephone_number": "201-624-1877",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "433 60th St Fl 1",
            "address_purpose": "LOCATION",
            "city": "West New York",
            "state": "NJ",
            "postal_code": "070932211",
            "country_code": "US",
            "telephone_number": "201-770-9995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORTEZ",
        "first_name": "GIANCARLO",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00774900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.