JOSIAH JAMES SURBATOVICH (NPI# 1275045791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275045791 |
| Entity Type | Individual |
| Full Name | JOSIAH JAMES SURBATOVICH |
| Credential | PHYSICIAN ASSISTANT |
| Practice Address |
170 West Ave Brockport NY 14420-1227 |
| Mailing Address |
105 Canal Landing Blvd Ste 1 Rochester NY 14626-5107 |
| Practice Telephone | 5853956052 |
| Practice Fax Number | 5853956007 |
| Mailing Telephone | 5853684050 |
| Mailing Fax Number | 5857236705 |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2018-01-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
021172 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
170 WEST AVE |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420-1227 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891791927 | Lakeside Beikirch Care Center, Inc. | Clinic/Center | 170 West Ave, Brockport, NY 14420-1227 | 2005-06-23 |
| 1245784271 | 170 West Avenue Operating Company, LLC | Skilled Nursing Facility | 170 West Ave, Brockport, NY 14420-1227 | 2016-08-08 |
| 1598830044 | William Michael Covell | Physical Therapist | 170 West Ave, Brockport, NY 14420-1227 | 2006-11-21 |
| 1235221458 | Karyn Felice | Nurse Practitioner | 170 West Ave, Brockport, NY 14420-1227 | 2006-09-28 |
| 1306868633 | Raj Mehta | Internal Medicine | 170 West Ave, Brockport, NY 14420-1227 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194217471 | Brianna Lynn Bunch | Licensed Practical Nurse | 126 White Road, Brockport, NY 14420 | 2018-06-03 |
| 1174012785 | Penny Bowers | Massage Therapist | 27 Market Street, Upstairs, Brockport, NY 14420 | 2018-05-09 |
| 1386172062 | Allison Manly | Dentist | 1000 Transit Way, Brockport, NY 14420 | 2017-05-25 |
| 1235518143 | Erin B Chapman | Physical Medicine & Rehabilitation | 350 New Campus Drive, Brockport, NY 14420 | 2015-05-26 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1689946303 | Beverly Whiteman | Registered Nurse | 40 Allen St., Brockport, NY 14420 | 2012-01-27 |
| 1316217425 | Julie Ann Knapp | Registered Nurse | 40 Allen Street, Brockport Central School District, Brockport, NY 14420 | 2012-01-05 |
| 1851678965 | Jennifer Anne Cohen | Registered Nurse | 188 Utica Street, Brockport, NY 14420 | 2011-11-03 |
| 1205088960 | Amy Maureen Hennessy | Obstetrics & Gynecology | 6668 Fourth Section Rd Ste 500, Brockport, NY 14420 | 2008-10-14 |
| 1053454884 | Nancy S Iafrati | Nurse Practitioner | Suny Brockport Student Health Center, 350 New Campus Drive, Brockport, NY 14420 | 2007-02-14 |
| Find all providers in zip 14420 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093784704 | Kelly Jean Halvonik | Physician Assistant | Interlakes Oncology & Hematology PC, 156 West Ave., Brockport, NY 14420 | 2006-03-15 |
| 1992773840 | Brenda M Spencer | Physician Assistant | 6668 Fourth Section Rd, Brockport, NY 14420-2448 | 2006-03-08 |
| 1043769326 | Emma L Leatham | Physician Assistant | 156 West Ave, Brockport, NY 14420-1229 | 2016-09-27 |
| 1104126549 | Lori Jeanne Mckee | Physician Assistant | 6668 Fourth Section Rd, Brockport, NY 14420-2448 | 2010-11-02 |
| 1750617072 | Shauna Marie Ketchum | Physician Assistant | 300 West Ave, Brockport, NY 14420-1118 | 2009-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487252581 | North Shore Medical Group Pllc | Physician Assistant | 311 Skyview Ter, Syracuse, NY 13219-2835 | 2020-10-12 |
| 1477169654 | Kristen Ariel O'connell | Physician Assistant | 85 John St Apt 7a, New York, NY 10038-2844 | 2020-09-22 |
| 1699381616 | David Nmn Kao | Physician Assistant | 737 Pleasant Avenue, Westbury, NY 11590-6407 | 2020-09-16 |
| 1043824816 | Elizabeth Keane | Physician Assistant | 25 Hollis Dr, Sound Beach, NY 11789-1629 | 2020-08-31 |
| 1497364111 | Tianna Stephens | Physician Assistant | 165 N Village Ave Ste 5, Rockville Centre, NY 11570-3701 | 2020-07-28 |
| 1124636188 | Shannon Maureen O'connell | Physician Assistant | 270-05 270th Ave, New Hyde Park, NY 11040 | 2020-07-16 |
| 1841818895 | Yanick Dugue | Physician Assistant | 4 Lincoln Ave, New Hyde Park, NY 11040-3125 | 2020-07-07 |
| 1194340505 | Kayleigh Marie Tourt | Physician Assistant | 222 Alexander St Fl 4, Rochester, NY 14607-4039 | 2020-06-11 |
| 1023638509 | Kristina Rajic | Physician Assistant | 7237 66th Dr, Flushing, NY 11379-2111 | 2020-04-24 |
| 1114547791 | Michele Hein | Physician Assistant | 700 Veterans Memorial Hwy, Hauppauge, NY 11788-2952 | 2020-04-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.