Wallie Kanishka, PHYSICIAN ASSISTANT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

25 Hitching Post LN
Glen Cove, NY 11542-1625

Phone

(801) 918-4155

NPI assigned

Aug 5, 2021

Last updated

Aug 5, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: wallie.kanishka@1056.chartlogic.direct-ci.com
• Direct secure messaging: wkanishka@montefioredirect.com

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.

• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  Medicare reassignment NPD (past)
• Richard S. Obedian MD PLLC

  • Orthopaedic Surgery Physician
  • Hicksville, NY
  • NPI 1386886984
  Medicare reassignment
• Montefiore Medical Center

  dba Montefiore Community Pharmacy @ CHAM

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Montefiore Medical Center

  • Family Medicine Physician
  • New York, NY
  • NPI 1760288278
  NPD

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628121600000",
    "number": "1659045235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HITCHING POST LN",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115421625",
            "telephone_number": "801-918-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HITCHING POST LN",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115421625",
            "telephone_number": "801-918-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANISHKA",
        "first_name": "WALLIE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nisha John Joseph, PHARMD
• JWG Physical Therapy PC (Gardiner Physical Therapy Services)
• Krystle Kalimnios
• Sarwat Kamal, MD
• Stefanie P Kane, LMSW CDCES
• Kanors Senior Center, Inc.
• Chinny Kapoor
• Argyro Karidis, M.D.
• Kathryn Calabria, DO,PC
• Leah Katz

• Student in an Organized Health Care Education/Training Program in Glen Cove, NY
• Providers in Glen Cove, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.