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

Luis Angel Riquelme III

Individual provider Medical Physician Assistant · NPI 1871933515

Luis Angel Riquelme III is a Physician Assistant in Stony Brook, New York. Qualified in 2013, 13 years ago. Practices with Stony Brook Surgical Associates University Faculty Practice Corporati, a 102-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
13
Licensed in
NY
In the registry since
2013
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Practice location Address checks out

101 Nicolls Rd
Stony Brook, NY 11794-3208
Phone: (631) 358-1201
Fax: (631) 444-8850
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 016630 (NY)

Record details

NPI number1871933515
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJune 26, 2013
Last updated in NPPESMay 9, 2024
Certification dateMay 9, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Stony Brook Surgical Associates University Faculty Practice Corporati — 102 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Stony Brook