Individual provider Active NPI

Natalie Klinoff, P.A.

  • Physician Assistant
  • Newark, NJ
National Provider Identifier
1750472346
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00114600 Issued in NJ
Practice address
111 Central Ave FL 3
Newark, NJ 07102-1909
Phone
(973) 877-5300
Fax
(973) 877-2621
NPI assigned
Sep 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 25MP00114600 NJ Primary

Addresses

Primary practice location

111 Central Ave FL 3
Newark, NJ 07102-1909

Mailing address

53 New LN
Staten Island, NY 10305-3105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 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
I20061221000308 NJ Practitioner - Physician Assistant 9638179633 Reassigns benefits to 3 organizations
I20191119003013 NY Practitioner - Physician Assistant 9638179633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys General Medical Group PCGroup PAC ID 5496112476, 73 clinicians

Practice addresses (Care Compare)

350 Boulevard
Passaic, NJ 07055-2840
Phone (973) 365-4300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
007786NYMDPharmacy Technician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Oct 2, 2019 Accepting new patients
Telehealth Core Physician Assistant Current Accepting new patients
Prime Healthcare Services - St. Mary's Passaic, LLC CurrentSince Feb 13, 2023 Accepting new patients
Cathedral Cardiac Specialists, PC Past Accepting new patients

Locations

111 Central Ave
Newark, NJ 07102
Phone (973) 877-5060

111 Central Ave
Fl 3
Newark, NJ 07102
Phone (973) 266-9111

350 Boulevard
Passaic, NJ 07055
Phone (973) 365-4300

300 Community Dr
Manhasset, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Interoperability endpoints

  • Direct secure messaging: nak9058@direct.weillcornell.org

Organizations & group practices 6

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 1

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750472346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 NEW LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 CENTRAL AVE FL 3",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071021909",
            "telephone_number": "973-877-5300",
            "fax_number": "973-877-2621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLINOFF",
        "first_name": "NATALIE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00114600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.