Individual provider Active NPI

Nikita Goltyapin, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1710445259
Registry record updated Feb 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
160 Broadway RM 1107
New York, NY 10038-4212
Phone
(212) 433-2956
Fax
(877) 682-2321
NPI assigned
Mar 4, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NJ Primary
Paramedic 146L00000X M5066222 OH
Basic Emergency Medical Technician 146N00000X 454020 NY

Addresses

Primary practice location

160 Broadway RM 1107
New York, NY 10038-4212

Mailing address

291 Melrose PL
South Orange, NJ 07079-1638
Phone (212) 500-1008

Other practice location 1

27 Whitehall St Fl 7
New York, NY 10004-2156
Phone (212) 500-1007

Other identifiers 1

IdentifierTypeStateIssuer
1578711891OtherNYNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 W Gilbert St
Tinton Falls, NJ 07701-4948

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
M5066222OHMDParamedic
454020NYMDBasic Emergency Medical Technician

NPI Registry JSON

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

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770595200000",
    "number": "1710445259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 MELROSE PL",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070791638",
            "telephone_number": "212-500-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 BROADWAY RM 1107",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100384212",
            "telephone_number": "212-433-2956",
            "fax_number": "877-682-2321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27 Whitehall St Fl 7",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100042156",
            "country_code": "US",
            "telephone_number": "212-500-1007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLTYAPIN",
        "first_name": "NIKITA",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-04",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": null,
            "primary": true
        },
        {
            "code": "146L00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": "OH",
            "license": "M5066222",
            "primary": false
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "NY",
            "license": "454020",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1578711891",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.