Individual provider Active NPI

Anton Roy Wineman Jr., PA-C

  • Physician Assistant
  • Fort Drum, NY
National Provider Identifier
1730536004
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
020791 Issued in NY
Practice address
11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Phone
(315) 774-3052
NPI assigned
May 17, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

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 020791 NY Primary

Addresses

Primary practice location

11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438

Mailing address

11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Phone (315) 774-3037

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: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
020791NYMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782086400000",
    "number": "1730536004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-774-3037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-774-3052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINEMAN",
        "first_name": "ANTON",
        "middle_name": "ROY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-17",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Drum, NY

Sources for this page

Verify at the official NPI Registry.