Mary Yegoryan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

023105-1 Issued in NY

Practice address

17 Glen Pond Dr Ste 4
Red Hook, NY 12571-1824

Phone

(845) 757-2482

NPI assigned

Mar 28, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Craig Austin Dermatology PCGroup PAC ID 1153308259, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

23.57 of 100Reported as group

Quality

47.14

Improvement activities

0

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Craig Austin Dermatology PC

  • Specialist
  • Fishkill, NY
  • NPI 1568649713
  Medicare reassignment Care Compare group
• BB Medical and Dermatology Inc

  • MOHS-Micrographic Surgery Physician
  • New York, NY
  • NPI 1790210516
  Medicare reassignment
• Optum Medical Care, P.C.

  • Cardiovascular Disease Physician
  • Mount Kisco, NY
  • NPI 1982643003
  Medicare reassignment
• Optum Medical Care, P.C.

  • Durable Medical Equipment & Medical Supplies
  • New Hyde Park, NY
  • NPI 1053190595
  NPD
• Alexandr Safarov Medical P.C.

  • Dermatology Physician
  • Red Hook, NY
  • NPI 1801719117
  NPD (past)

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1992266233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 GLEN POND DR STE 4",
            "city": "RED HOOK",
            "state": "NY",
            "postal_code": "125711824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 GLEN POND DR STE 4",
            "city": "RED HOOK",
            "state": "NY",
            "postal_code": "125711824",
            "telephone_number": "845-757-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEGORYAN",
        "first_name": "MARY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-28",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "023105-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Devereux Foundation
• Stacie Marie Totman, OTR/L
• Caroline Isabelle Tuton, LPN
• Kimberley Vanpelt-Cathcart, LPN
• Jana Gale Vengrin, NP
• Theresa Marie Yonker, MD
• Zachary Yale Barletta Psychology, PLLC

• Physician Assistant in Red Hook, NY
• Providers in Red Hook, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.