Individual provider Active NPI

Itah Weinberger

  • Physician Assistant
  • Staten Island, NY
National Provider Identifier
1609349406
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
023049-1 Issued in NY
Practice address
355 Bard Ave
Staten Island, NY 10310-1664
Phone
(718) 818-1234
NPI assigned
Jan 4, 2019
Last updated
Jan 4, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

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 023049-1 NY Primary

Addresses

Primary practice location

355 Bard Ave
Staten Island, NY 10310-1664

Mailing address

1440 E 27TH St
Brooklyn, NY 11210-5309
Phone (718) 954-6802

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190214001443 NY Practitioner - Physician Assistant 2062750102 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nyack Emergency Medical Association PLLCGroup PAC ID 2062411036, 59 clinicians
Medcare, LLCGroup PAC ID 9537265541, 15 clinicians
Friendly Urgent Care of Ny PLLCGroup PAC ID 0749510469, 7 clinicians

Practice addresses (Care Compare)

160 N Midland Ave
Nyack, NY 10960-1912
Phone (954) 939-5000

468 Lafayette Ave
Brooklyn, NY 11205-4809
Phone (718) 399-6234

77 Route 59
Suite 103
Monsey, NY 10952-3739
Phone (845) 356-2273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
023049NYMDSpeech-Language Pathologist
023049-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medcare, LLC CurrentSince Sep 28, 2025 Accepting new patients
Parcare Community Health Network Inc CurrentSince Apr 19, 2020 Accepting new patients
Lafayette Medical Office, PC PastSince Sep 28, 2025 Accepting new patients

Locations

445 Park Ave
Brooklyn, NY 11205
Phone (718) 965-1320

468 Lafayette Ave
Brooklyn, NY 11205
Phone (718) 399-6234

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1609349406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 E 27TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112105309",
            "telephone_number": "718-954-6802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINBERGER",
        "first_name": "ITAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-04",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "023049-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.