Individual provider Active NPI

Esther Roshan Shad, MS, PA-C

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1891192092
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
018102 Issued in NY
Practice address
5601 1St Ave
Brooklyn, NY 11220-2517
Phone
(718) 942-3888
NPI assigned
Dec 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 018102 NY Primary
Physician Assistant 363A00000X 164119 NY

Addresses

Primary practice location

5601 1St Ave
Brooklyn, NY 11220-2517

Mailing address

5601 1St Ave
Brooklyn, NY 11220-2517
Phone (718) 942-3888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20220106002537 NY Practitioner - Physician Assistant 7517358260 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
164119NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hasc Diagnostic & Treatment Center, Inc CurrentSince Dec 1, 2021 Accepting new patients
Hasc Diagnostic & Treatment Center, Inc CurrentSince Dec 1, 2021 Accepting new patients
Boro Park Pediatric Associates, PLLC Past Accepting new patients
Premium Health Inc Past Accepting new patients

Locations

5601 1st Ave
Brooklyn, NY 11220
Phone (718) 650-0110

1221 E 14th St
Brooklyn, NY 11230
Phone (718) 434-4600

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

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": "1417564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1891192092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 1ST AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112202517",
            "telephone_number": "718-942-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 1ST AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112202517",
            "telephone_number": "718-942-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSHAN SHAD",
        "first_name": "ESTHER",
        "credential": "MS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-03",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018102",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "164119",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.