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

Tara Rose Nizamov, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1558179093

Tara Rose Nizamov, PHYSICIANASSISTANT is a Physician Assistant in Mount Vernon, New York. Graduated from Mercy College in 2024, 2 years ago. Practices with Cogent Medical Care PC, a 154-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
2
Trained at
Mercy College
Licensed in
NY
In the registry since
2024
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Practice location Address checks out

12 N 7th Ave
Mount Vernon, NY 10550-2026
Phone: (917) 557-9895
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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 032848 (NY)

Record details

NPI number1558179093
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedDecember 30, 2024
Last updated in NPPESJune 8, 2025
Certification dateJune 8, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMERCY COLLEGE
Graduated 2024 (2 years in practice)
Group practice Cogent Medical Care Pc — 154 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Mount Vernon