Nicholas Michael Kostishak Jr., PA-C, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

024450 Issued in NY

Practice address

1000 10TH Ave # 2A05
New York, NY 10019-1147

Phone

(516) 375-6459

NPI assigned

Dec 12, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

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

Locations

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.

• Icahn School of Medicine at Mount Sinai

  dba Orthopedic Department of Mount Sinai

  • Orthopaedic Surgery Physician
  • New York, NY
  • NPI 1124550280
  Medicare reassignment NPD
• Icahn School of Medicine at Mount Sinai

  dba New York Eye & Ear Optical Shop

  • Eyewear Supplier
  • New York, NY
  • NPI 1760227466
  NPD
• Icahn School of Medicine at Mount Sinai

  dba OB/GYN Department of Mount Sinai

  • Obstetrics & Gynecology Physician
  • New York, NY
  • NPI 1124392212
  NPD (past)

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

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1487085676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3469 STEPHEN LN",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117933105",
            "telephone_number": "516-375-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE # 2A05",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "516-375-6459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3469 Stephen Ln",
            "address_purpose": "LOCATION",
            "city": "Wantagh",
            "state": "NY",
            "postal_code": "117933105",
            "country_code": "US",
            "telephone_number": "516-375-6459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSTISHAK",
        "first_name": "NICHOLAS",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-12-12",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "002702",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "024450",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "1134",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Judith Kostant, M.D
• Kostas a. Katsavdakis, PHD, PC
• Nicholas Mark Kostelec, NP
• Tonya Kostenko, LMT
• Adrianne R Koster, DDS
• Oksana Kostko, M.D.
• Calliope Kostopoulos
• Katrina Brody Kostro
• Khrystyna Kostsyuh, D.D.S.
• Sarah Anne Kosturos, DPT

• Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.