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NPI 1609737196ActiveIndividual· Physician Assistant· Elmhurst, NY
Physician Assistant in Elmhurst, New York, licensed in NY, with an NPI issued in November 2025. Enrolled in Medicare as practitioner - physician assistant.
Overview
| NPI | 1609737196 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | Yes |
| NPI issued | Nov 24, 2025 |
| Last updated in NPPES | Dec 28, 2025 |
| Certified by provider | Dec 28, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 035062 | NY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (NY) |
|---|
Education and affiliations
| Graduation year | 2025 |
|---|---|
| Medicare specialty | Physician Assistant |
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 149 physician assistants in Elmhurst · All physician assistants in New York