Corinna Luise Mendis, R.PA.C.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

012299 Issued in NY

Practice address

2500 Nesconset Hwy
BLDG 21C
Stony Brook, NY 11790-2555

Phone

(631) 246-8289

Fax

(631) 246-8294

NPI assigned

Dec 17, 2007

Last updated

Dec 17, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Port Emergency Medical Services, P.C.

  • Emergency Medicine Physician
  • Port Jefferson, NY
  • NPI 1912988395
  Medicare reassignment
• Samaritan Medical Services, P.C.

  • Internal Medicine Physician
  • West Islip, NY
  • NPI 1124184544
  Medicare reassignment
• Vascular Associates of Long Island, PC

  • Vascular Surgery Physician
  • East Setauket, NY
  • NPI 1245415322
  NPD (past)

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1467635169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HIGHWAY",
            "address_2": "BLDG 21C",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11790",
            "telephone_number": "631-246-8289",
            "fax_number": "631-246-8294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HWY",
            "address_2": "BLDG 21C",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902555",
            "telephone_number": "631-246-8289",
            "fax_number": "631-246-8294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDIS",
        "first_name": "CORINNA",
        "middle_name": "LUISE",
        "credential": "R.PA.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "012299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vartan Zavenovich Melkumov, DDS
• Tehsim Aziz Memon, MBBS, MD
• Hayley Alexandra Mena, LMSW
• Eyal Menashe
• Mendelsohn Medical, PLLC
• Sam Tarik Mendoune I, NP
• Michelle Menezes
• Richard S Menjivar, PMHNP
• Julie Mercado, DMD
• Amanda Mercurio, PHARM.D.

• Surgical Physician Assistant in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.