Active NPI
Hanna Mardakh, PA
- Physician Assistant
- Staten Island, NY
National Provider Identifier
1588034946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 018932
- Practice address
- 269 Ashland Ave
Staten Island, NY 10309-3002 - Phone
- (917) 330-8988
- NPI assigned
- Sep 29, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | 018932 | NY | Primary |
Addresses
Primary practice location
269 Ashland Ave
Staten Island, NY 10309-3002
Mailing address
269 Ashland Ave
Staten Island, NY 10309-3002
Phone (917) 330-8988
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 |
|---|---|---|---|
| 018932 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443484800000",
"number": "1588034946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "269 ASHLAND AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103093002",
"telephone_number": "917-330-8988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "269 ASHLAND AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103093002",
"telephone_number": "917-330-8988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARDAKH",
"first_name": "HANNA",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-29",
"last_updated": "2015-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "018932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.