Individual provider Active NPI

Marina Katanova, PA

  • Physician Assistant
  • Long Island City, NY
National Provider Identifier
1699163774
Registry record updated Dec 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
018161 Issued in NY
Practice address
2510 30TH Ave
Long Island City, NY 11102-2448
Phone
(718) 267-4390
NPI assigned
Dec 24, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2014

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 018161 NY Primary

Addresses

Primary practice location

2510 30TH Ave
Long Island City, NY 11102-2448

Mailing address

6550 Wetherole St Apt 1U
Apt 1U
Rego Park, NY 11374-4715
Phone (347) 612-2547

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

LicenseStateTypeSpecialty
018161NYMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: mak9181@direct.nyp.org

NPI Registry JSON

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

{
    "created_epoch": "1419379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419379200000",
    "number": "1699163774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 WETHEROLE ST APT 1U",
            "address_2": "APT 1U",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744715",
            "telephone_number": "347-612-2547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 30TH AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111022448",
            "telephone_number": "718-267-4390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATANOVA",
        "first_name": "MARINA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-24",
        "last_updated": "2014-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2014; 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.