Unknown Individual – Surgical Physician Assistant, NPI 1912920224

Surgical Physician Assistant

Unknown Individual is a healthcare provider. based in Carmel, New York. specializing in Surgical Physician Assistant. They hold a License No. 4188 (CT). The NPI Number for Unknown Individual is 1912920224

Main info

Organization

Inactive

25 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1912920224

Phone

(845) 278-8400

Address

664 STONELEIGH AVE STE 300

Deactivation Date

1 February 2023

Doctor Profile

Medical School Name

NEW YORK UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

8452788400

Graduation Year

2001 (25 years ago)

PAC ID

9234116211

Group Practice PAC ID

9638061674

Professional Enrollment ID

I20040707000984

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience28

Completeness75

Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

664 STONELEIGH AVE STE 300
CARMEL, NY 105123990
Phone: (845) 278-8400
Fax: (845) 278-4326
Type: Mailing
40 Old Ridgebury Rd Ste 101
Danbury, CT 068105119
Phone: (845) 278-8400
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 10512)

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Provider's Procedures

Unknown Individual performs procedures in Surgical Physician Assistant. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
PHYSICIAN ASSISTANT	NY	27447	Repair of knee joint	48	45

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9638061674View full group profile

Name	Specialty	State
MR. JOSEPH MICHAEL JR. PERUCCI (PA)	Physician Assistant	NY
DR. YARIV MAGHEN (M.D.)	Orthopedic Surgery, Hand Surgery	NY
DOUGLAS FAUSER (MD)	Orthopedic Surgery	CT
LAURA KLEIN (FNP)	Nurse Practitioner	CT
JOEL S BUCHALTER (MD)	Orthopedic Surgery	CT
KIMBERLY GAUBE (FNP)	Nurse Practitioner	NY
DANIEL HOWARD	Orthopedic Surgery, Sports Medicine	NY
STUART STYLES (MD)	Orthopedic Surgery	CT
DOMINIQUE CARTICA (NP)	Nurse Practitioner	NY
SCOTT GRAY (M.D.)	-	CT