Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Gregory Baumgartner

Individual provider Physician Assistant · NPI 1205488970

Gregory Baumgartner is a Physician Assistant in Centereach, New York. Qualified in 2019, 7 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
7
Licensed in
NY
In the registry since
2019
Specialties on file
2

Practice location Address checks out

122 Ronkonkoma Blvd
Centereach, NY 11720-3314
Phone: (631) 655-6484
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Physician Assistant Taxonomy 363A00000X · Licence 024218 (NY)

Record details

NPI number1205488970
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 12, 2019
Last updated in NPPESFebruary 5, 2021
Certification dateFebruary 5, 2021
Mailing address122 Ronkonkoma Blvd, Centereach, NY 11720-3314

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Centereach