Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Michael Robert Licata, MSPAS, PA-C

Individual provider Physician Assistant · NPI 1417768334

Michael Robert Licata, MSPAS, PA-C is a Physician Assistant in Mineola, New York. Qualified in 2024, 2 years ago. Practices with True North Medical Group PC, a 186-clinician group and accepts Medicare assignment.

Years since qualifying
2
In the registry since
2025
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

161 Willis Ave
Mineola, NY 11501-2616
Phone: (516) 280-6645
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1417768334
Entity typeIndividual (Type 1)
GenderMale
Credentials MSPAS , PA-C
Sole proprietorYes
NPI enumeratedJanuary 20, 2025
Last updated in NPPESJanuary 20, 2025
Certification dateJanuary 19, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice True North Medical Group Pc — 186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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