Individual provider Active NPI

Jane Moldovan, PA-C

  • Physician Assistant
  • Stony Brook, NY
National Provider Identifier
1689125312
Registry record updated Oct 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
020032-1 Issued in NY
Practice address
Stony Brook University Hosp Dept Ofem
HSC, Level 4, Room 080
Stony Brook, NY 11794-8350
Phone
(631) 444-2499
NPI assigned
Oct 18, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2016

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 020032-1 NY Primary

Addresses

Primary practice location

Stony Brook University Hosp Dept Ofem
HSC, Level 4, Room 080
Stony Brook, NY 11794-8350

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988

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
I20161202000967 NY Practitioner - Physician Assistant 3971883281 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
020032-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospital at Stony Brook Current Accepting new patients

Locations

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Interoperability endpoints

  • Direct secure messaging: jane.moldovan@direct.stonybrookmedicine.edu

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477008000000",
    "number": "1689125312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1554",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STONY BROOK UNIVERSITY HOSP DEPT OFEM",
            "address_2": "HSC, LEVEL 4, ROOM 080",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948350",
            "telephone_number": "631-444-2499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLDOVAN",
        "first_name": "JANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020032-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.