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

Individual provider Physician Assistant · NPI 1033163035

Igor Lizogubenko, PA is a Physician Assistant in Port Jefferson, New York. Qualified in 2001, 25 years ago. Practices with John T Mather Memorial Hospital, a 180-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
25
Licensed in
NY
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone: (631) 474-6000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 008125-1 (NY)

Record details

NPI number1033163035
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 22, 2006
Last updated in NPPESJanuary 16, 2008

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Group practice John T Mather Memorial Hospital — 180 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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