Individual provider Active NPI

Alexander Avdashenko, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1699964262
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-14359 Issued in NC
Practice address
100 East 77TH Street
New York, NY 10021-1883
Phone
(917) 541-5378
NPI assigned
Oct 19, 2007
Last updated
Feb 23, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-14359 NC Primary
Physician Assistant 363A00000X 012117 NY

Addresses

Primary practice location

100 East 77TH Street
New York, NY 10021-1883

Mailing address

2006 Benson Ave Apt 3G
Brooklyn, NY 11214-4826
Phone (917) 541-5378

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120814000454 NY Practitioner - Physician Assistant 7315193976 Reassigns benefits to 2 organizations
I20251112002779 NC Practitioner - Physician Assistant 7315193976 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Century Medical and Dental Center IncGroup PAC ID 8729070669, 107 clinicians
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

180 Myrtle Ave
Brooklyn, NY 11201-7059
Phone (718) 650-2233

200 Livingston St
Brooklyn, NY 11201-5811
Phone (718) 522-3399

2315 3Rd Ave
New York, NY 10035-1733
Phone (212) 540-5020

260 Ave X
Brooklyn, NY 11223-5940
Phone (718) 336-8855

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7270

425 Westchester Ave
Bronx, NY 10455-1795
Phone (718) 705-2555

770 Flatbush Ave
Brooklyn, NY 11226-1902
Phone (347) 627-3988

827 11TH Ave
New York, NY 10019-3535
Phone (212) 369-5566

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-14359NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Jul 1, 2012 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Oct 20, 2025 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Oct 20, 2025 Accepting new patients
Wakemed Specialists Group, LLC Current Accepting new patients

Locations

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

3324 Six Forks Rd
Raleigh, NC 27609
Phone (919) 781-7772

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Manhasset, NY 11030

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: aavdashenko23511@northwell.direct-ci.com
  • Direct secure messaging: aavdashenko601582@directhisp.wakemed.org

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1699964262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 BENSON AVE APT 3G",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112144826",
            "telephone_number": "917-541-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EAST 77TH STREET",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100211883",
            "telephone_number": "917-541-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVDASHENKO",
        "first_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-19",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-14359",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "012117",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.