Individual provider Active NPI

Nancy Elena Trejo, RPA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1811162563
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
05034-1 Issued in NY
Practice address
525 East 68TH Room, M-528
Dept. of Medicine, Box 130
New York, NY 10065
Phone
(212) 746-4209
NPI assigned
Apr 24, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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 05034-1 NY Primary

Addresses

Primary practice location

525 East 68TH Room, M-528
Dept. of Medicine, Box 130
New York, NY 10065

Mailing address

3003 New Hyde Park Rd Ste 401
New Hyde Park, NY 11042-1214
Phone (516) 224-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 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
I20190520001973 NY Practitioner - Physician Assistant 0446593289 Reassigns benefits to 2 organizations
I20260511003933 NJ Practitioner - Physician Assistant 0446593289 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

404 Chestnut St
Apt 41
Newark, NJ 07105-2467

523 Park Ave
Orange, NJ 07050-1703

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
05034-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Apr 9, 2019 Accepting new patients

Locations

3003 New Hyde Park Rd
Ste 401
New Hyde Park, NY 11042
Phone (516) 224-2400

300 Community Dr
Plandome, NY 11030

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1811162563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 NEW HYDE PARK RD STE 401",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421214",
            "telephone_number": "516-224-2400",
            "fax_number": "516-224-2461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 EAST 68TH ROOM, M-528",
            "address_2": "DEPT. OF MEDICINE, BOX 130",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10065",
            "telephone_number": "212-746-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREJO",
        "first_name": "NANCY",
        "middle_name": "ELENA",
        "name_prefix": "Ms.",
        "credential": "RPA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "05034-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.