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

Nicolas Mavromoustakos

Individual provider Physician Assistant · NPI 1003440504

Nicolas Mavromoustakos is a Physician Assistant in Huntington, New York. Qualified in 2020, 6 years ago. Practices with Bon Secours Medical Group Greenville Specialty Care LLC, a 289-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
6
Licensed in
NY
In the registry since
2020
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Practice location Address checks out

14 Birch Ave
Huntington, NY 11743-4655
Phone: (631) 662-5714
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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 026722 (NY)

Record details

NPI number1003440504
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 24, 2020
Last updated in NPPESJuly 15, 2021
Certification dateJune 30, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Bon Secours Medical Group Greenville Specialty Care Llc — 289 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Huntington