Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kristen Marie Kotak, PA-C

Individual provider Physician Assistant · NPI 1942625702

Kristen Marie Kotak, PA-C is a Physician Assistant in Massapequa, New York. Qualified in 2014, 12 years ago. Practices with New York University, a 5,884-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
12
Licensed in
NY
In the registry since
2014
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

193 Baltimore Ave
Massapequa, NY 11758-4229
Phone: (516) 395-8767
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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 017420 (NY)

Record details

NPI number1942625702
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 3, 2014
Last updated in NPPESMarch 3, 2014

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice New York University — 5884 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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