Individual provider Active NPI

Kathryn Iris Marchessault, PA-C

  • Physician Assistant
  • Hoboken, NJ
National Provider Identifier
1861106510
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
308 Willow Ave
Hoboken, NJ 07030-3808
Phone
(201) 418-1000
NPI assigned
Jan 9, 2023
Last updated
Jan 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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 Primary

Addresses

Primary practice location

308 Willow Ave
Hoboken, NJ 07030-3808

Mailing address

115 E Rogues Path
Huntington Station, NY 11746-2741
Phone (631) 885-0227

Other practice location 1

176 Palisade Ave
Jersey City, NJ 07306-1121
Phone (201) 795-8200

Other practice location 2

29 E 29th St
Bayonne, NJ 07002-4654
Phone (201) 858-5000

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
I20230216002499 NJ Practitioner - Physician Assistant 1153793351 Reassigns benefits to 1 organization
I20241230000723 NY Practitioner - Physician Assistant 1153793351 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
029503NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Feb 1, 2025 Accepting new patients
New York University CurrentSince Feb 1, 2025 Accepting new patients

Locations

700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325

Interoperability endpoints

  • Direct secure messaging: kmarchessault686328@nyumc.direct-ci.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1861106510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 E ROGUES PATH",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117462741",
            "telephone_number": "631-885-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 WILLOW AVE",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070303808",
            "telephone_number": "201-418-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "176 Palisade Ave",
            "address_purpose": "LOCATION",
            "city": "Jersey City",
            "state": "NJ",
            "postal_code": "073061121",
            "country_code": "US",
            "telephone_number": "201-795-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "29 E 29th St",
            "address_purpose": "LOCATION",
            "city": "Bayonne",
            "state": "NJ",
            "postal_code": "070024654",
            "country_code": "US",
            "telephone_number": "201-858-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARCHESSAULT",
        "first_name": "KATHRYN",
        "middle_name": "IRIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoboken, NJ

Sources for this page

Verify at the official NPI Registry.