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

Mark Granados

Individual provider Physician Assistant · NPI 1871101006

Mark Granados is a Physician Assistant in Roslyn, New York. Qualified in 2017, 9 years ago. Practices with Modern Physician Services PC, a 53-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
9
Licensed in
NY
In the registry since
2020
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Practice location Address checks out

100 Port Washington Blvd
Roslyn, NY 11576-1347
Phone: (516) 562-6000
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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 025159 (NY)

Record details

NPI number1871101006
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 14, 2020
Last updated in NPPESJuly 14, 2020
Certification dateJuly 14, 2020
Mailing address195 Elm Dr, Bay Shore, NY 11706-2135

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Modern Physician Services Pc — 53 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Roslyn