Michele Camille Iacoviello, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

777 Zeckendorf Blvd
Garden City, NY 11530-2126

Phone

(516) 832-8870

NPI assigned

Jan 15, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: micheleiacoviello@nslijmedgr.allscriptsdirect.net

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650240000000",
    "number": "1780158501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 WHEELER DR",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117462645",
            "telephone_number": "631-629-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 ZECKENDORF BLVD",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115302126",
            "telephone_number": "516-832-8870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACOVIELLO",
        "first_name": "MICHELE",
        "middle_name": "CAMILLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-15",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "005017",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Hussey, M.D.
• Patrice Hutson
• Sheri Beth Hyman, MSW, LCSW
• Adam Tyler Hymowitz, ATC
• I S Services Inc
• Bassiema B Ibrahim, MD
• Icahn School of Medicine at Mount Sinai
• Igal Rahmani MD PC
• Kelly Imperial, MSW-LP
• Infant Feeding Specialists, Inc

• Physician Assistant in Garden City, NY
• Providers in Garden City, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.