Provider Demographics
NPI:1356362479
Name:NEUBAUER, JOANNA ELIZABETH (PA)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:ELIZABETH
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:ELIZABETH
Other - Last Name:BERNARDINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2418 LEGION ST
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:718-809-8785
Mailing Address - Fax:203-863-3821
Practice Address - Street 1:CITY MD 1345 AVENUE OF THE AMERICAS SUITE 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10105
Practice Address - Country:US
Practice Address - Phone:855-624-8963
Practice Address - Fax:203-863-3821
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P68881Medicare UPIN
NYA400014076Medicare PIN
CT970002033Medicare ID - Type Unspecified