NPIMap

Organization Active NPI

An Physician Assistant PC

  • Physician Assistant
  • Smithtown, NY
National Provider Identifier
1609456649
Registry record updated Apr 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
AN PHYSICIAN ASSISTANT PC
Practice address
6 Colony CT
Smithtown, NY 11787-2507
Phone
(631) 255-9551
NPI assigned
Apr 13, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2021

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

Authorized official

Name
Alexander Niyazov, PANPI 1265988778
Title
Physician Assistant
Phone
(631) 255-9551

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

6 Colony CT
Smithtown, NY 11787-2507

Mailing address

6 Colony CT
Smithtown, NY 11787-2507

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1618272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618358400000",
    "number": "1609456649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 COLONY CT",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 COLONY CT",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872507",
            "telephone_number": "631-255-9551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AN PHYSICIAN ASSISTANT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-13",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A",
        "authorized_official_last_name": "NIYAZOV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "631-255-9551",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.