Active NPI
Glenn David Visconti Jr., PA-C
- Physician Assistant
- Astoria, NY
National Provider Identifier
1467903948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 020281
- Practice address
- 2638 21St St
Apt 5J
Astoria, NY 11102-3651 - Phone
- (845) 857-4128
- NPI assigned
- Oct 19, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 020281 | NY | Primary |
Addresses
Primary practice location
2638 21St St
Apt 5J
Astoria, NY 11102-3651
Mailing address
26-38 21 St
Apt 5J
Astoria, NY 11102
Phone (845) 857-4128
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020281 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1467903948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26-38 21 ST",
"address_2": "APT 5J",
"city": "ASTORIA",
"state": "NY",
"postal_code": "11102",
"telephone_number": "845-857-4128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2638 21ST ST",
"address_2": "APT 5J",
"city": "ASTORIA",
"state": "NY",
"postal_code": "111023651",
"telephone_number": "845-857-4128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VISCONTI",
"first_name": "GLENN",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-19",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "020281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Astoria, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.