Ajay Misra, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

189741 Issued in NY

Practice address

880 N Broadway
Massapequa, NY 11758-2351

Phone

(516) 541-0300

NPI assigned

Feb 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amisra230674@nyumc.direct-ci.com

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.

• New York University

  • Cardiovascular Disease Physician
  • Boynton Beach, FL
  • NPI 1285826438

  NY

  Medicare reassignment NPD
• New York University

  • Physical Medicine & Rehabilitation Physician
  • Boynton Beach, FL
  • NPI 1104787613
  NPD
• Winthrop Community Medical Affiliates PC

  • Internal Medicine Physician
  • Mineola, NY
  • NPI 1457873077
  NPD (past)

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1508832148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 N BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582351",
            "telephone_number": "516-541-0300",
            "fax_number": "516-541-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 N BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582351",
            "telephone_number": "516-541-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISRA",
        "first_name": "AJAY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "189741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amisra230674@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "880 N Broadway",
            "city": "Massapequa",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117582351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Keisha Miller
• Lauren Bernice Miller
• Michelle Miller
• Constance Mintz, RN
• Christina Marie Misita
• Michael Mistretta, DDS
• Susan Rebecca Mitchell, P.A.
• Marissa Mobilia, ANP-C
• Erica Modena
• Nina Modest, LPN

• Specialist in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; 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.