NPIMap

Individual provider Active NPI

Julian Marynczak, PA

  • Physician Assistant
  • Glens Falls, NY
National Provider Identifier
1528059961
Registry record updated Jul 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
005903 Issued in NY
Practice address
100 Park St
Glens Falls Hospital
Glens Falls, NY 12801
Phone
(518) 926-5918
Fax
(518) 926-5917
NPI assigned
Nov 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2018

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 005903 NY Primary

Addresses

Primary practice location

100 Park St
Glens Falls Hospital
Glens Falls, NY 12801

Mailing address

PO Box 304
Glens Falls, NY 12801-0304
Phone (518) 926-5918

Other practice location 1

2215 Burdett Ave
Troy, NY 12180-2466
Phone (518) 271-3300

Other identifiers 2

IdentifierTypeStateIssuer
970013888OtherNYRR MEDICARE
02347955MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100217000216 NY Practitioner - Physician Assistant 5193869964 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glens Falls Hospital IncGroup PAC ID 8325955974, 175 clinicians

Practice addresses (Care Compare)

100 Park St
Glens Falls, NY 12801-4413
Phone (518) 926-1000

79 N St
Granville Medical Center
Granville, NY 12832-1137
Phone (518) 642-0612

Hospital & facility affiliations

  • Glens Falls Hospital Hospital, Glens Falls, NY, CCN 330191
  • Albany Medical Center Hospital Hospital, Albany, NY, CCN 330013

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Glens Falls Hospital Inc CurrentSince Apr 3, 2000 Accepting new patients
Samaritan Hospital of Troy, New York Physician Assistant CurrentSince Aug 27, 2018 Accepting new patients
Samaritan Hospital of Troy, New York Physician Assistant CurrentSince Aug 27, 2018 Accepting new patients
Glens Falls Hospital Inc Past Accepting new patients

Locations

100 Park St
Glens Falls, NY 12801
Phone (518) 926-5924

79 North St
Granville, NY 12832
Phone (518) 642-0612

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

Interoperability endpoints

  • Direct secure messaging: jmarynczak100014@albanymed.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532649600000",
    "number": "1528059961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 304",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128010304",
            "telephone_number": "518-926-5918",
            "fax_number": "518-926-5917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PARK ST",
            "address_2": "GLENS FALLS HOSPITAL",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "12801",
            "telephone_number": "518-926-5918",
            "fax_number": "518-926-5917"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2215 Burdett Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121802466",
            "country_code": "US",
            "telephone_number": "518-271-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARYNCZAK",
        "first_name": "JULIAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2018-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "005903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "970013888",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02347955",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glens Falls, NY

Sources for this page

Verify at the official NPI Registry.