Active NPI
Supranee Prombanthoa, PA
- Physician Assistant
- East Meadow, NY
National Provider Identifier
1942442223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 012965
- Practice address
- 2201 Hempstead Tpke
East Meadow, NY 11554-1859 - Phone
- (516) 572-6501
- Fax
- (516) 572-5609
- NPI assigned
- Apr 1, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 012965 | NY | Primary |
Addresses
Primary practice location
2201 Hempstead Tpke
East Meadow, NY 11554-1859
Mailing address
2201 Hempstead Tpke
East Meadow, NY 11554-1859
Phone (516) 572-6501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012965 | Other | NY | NYS LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238544000000",
"number": "1942442223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 HEMPSTEAD TPKE",
"city": "EAST MEADOW",
"state": "NY",
"postal_code": "115541859",
"telephone_number": "516-572-6501",
"fax_number": "516-572-5609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 HEMPSTEAD TPKE",
"city": "EAST MEADOW",
"state": "NY",
"postal_code": "115541859",
"telephone_number": "516-572-6501",
"fax_number": "516-572-5609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROMBANTHOA",
"first_name": "SUPRANEE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-01",
"last_updated": "2009-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "012965",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS LICENSE NUMBER",
"identifier": "012965",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Meadow, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.