Active NPI
Joan M Petith-Paulsen, PA
- Physician Assistant
- Amsterdam, NY
National Provider Identifier
1952561649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001757
- Practice address
- 4803 State Highway 30
Kem Plaza
Amsterdam, NY 12010-7418 - Phone
- (518) 842-0285
- NPI assigned
- Jun 16, 2008
- 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 | 001757 | NY | Primary |
Addresses
Primary practice location
4803 State Highway 30
Kem Plaza
Amsterdam, NY 12010-7418
Mailing address
4803 State Highway 30
Kem Plaza
Amsterdam, NY 12010-7418
Phone (518) 842-0285
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001757 | Other | NY | LICENSE |
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": "1213574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213574400000",
"number": "1952561649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4803 STATE HIGHWAY 30",
"address_2": "KEM PLAZA",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "120107418",
"telephone_number": "518-842-0285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4803 STATE HIGHWAY 30",
"address_2": "KEM PLAZA",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "120107418",
"telephone_number": "518-842-0285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETITH-PAULSEN",
"first_name": "JOAN",
"middle_name": "M",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-16",
"last_updated": "2008-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "001757",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "001757",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amsterdam, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.