Raphaela Gassanov, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

029741 Issued in NY

Practice address

110 W 14TH St
New York, NY 10011-7303

Phone

(212) 481-3333

NPI assigned

Mar 28, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13555/brand/1/csg/1/fhir/r4
• Direct secure messaging: raphaela.gassanov.1@13555.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 14 Street Medical, PC

  • Internal Medicine Physician
  • New York, NY
  • NPI 1386091486
  NPD (past)

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1780388454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 E 18TH ST APT 6C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112307567",
            "telephone_number": "732-239-9288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W 14TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100117303",
            "telephone_number": "212-481-3333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "912 Columbus Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100254040",
            "country_code": "US",
            "telephone_number": "212-481-3333",
            "fax_number": "212-420-5925",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "332 E 14th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100034243",
            "country_code": "US",
            "telephone_number": "212-481-3333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GASSANOV",
        "first_name": "RAPHAELA",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "029741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruth Elizabeth Gasparik, LCSW ; CASAC
• Justin Timothy Gasper
• Caitlin E Gasperetti
• Diana Gasperoni
• Goundoul Gassama
• Olivia Catherine Gasser, PNP, RN
• Steven Tobias Gasser, LMSW
• Kyra Gassmann, MD
• Suzanna Gasso, MSN, AGACNP, CCRN
• Michael Gast, L.C.S.W.

• Medical Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.