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IGOR LIZOGUBENKO P.A.
NPI 1033163035
Physician Assistant in Port Jefferson, NY

Active since May 22, 2006PECOS Enrolled
200 BELLE TERRE RD, PORT JEFFERSON, NY 11777(631) 474-6000 Get Directions Write a Review

NPPES record last updated: January 16, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Igor Lizogubenko P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IGOR LIZOGUBENKO P.A. (NPI 1033163035) is an individual physician assistant in Port Jefferson, New York, licensed in New York (008125-1) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1033163035
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameIGOR LIZOGUBENKOCredential: P.A.
Location Address200 BELLE TERRE RDPort Jefferson, NY 11777-1928
Mailing AddressPo Box 826207Philadelphia, PA 19182-6207 · (800) 377-8721 · Fax (304) 523-2241
Phone(631) 474-6000
Sole ProprietorNo
Enumeration DateMay 22, 2006
Last NPPES UpdateJanuary 16, 2008
✔ NPI 1033163035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 008125-1
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
200 BELLE TERRE RD, Port Jefferson, NY 11777
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Other Identifiers 3

Medicare PIN6237LBW991NY
Medicare PINP00315987NY
Medicare UPINP79831

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Igor Lizogubenko P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11777 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANTHONY BRIAN KWAN MD
Emergency Medicine
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6791
MR. TERENCE JOSEPH SCHULZ MA CCC-A
Audiologist-Hearing Aid Fitter
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6326
MS. LAURA LYNN BECK PT
Physical Therapist
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 476-5606
RONNI MARANGONI
Occupational Therapist (Pediatrics)
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6267
SANA AMBER HAMEEDI D.O
Pediatrics
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6000
MR. MATTHEW DELPH PA
Physician Assistant
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6000
DR. ROBERT KENNEDY AWADALLAH PHARM.D, ANP, MBA
Pharmacist
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6000
MARSHEL MARION SINGLETON RN
Nurse Practitioner (Family)
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (904) 372-3943

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Igor Lizogubenko's NPI number?

The NPI number for Igor Lizogubenko is 1033163035. It was assigned to this individual provider in the NPPES registry on May 22, 2006.

Where is Igor Lizogubenko located?

Igor Lizogubenko practices at 200 Belle Terre Rd, Port Jefferson, NY 11777. The listed phone number is (631) 474-6000.

What is Igor Lizogubenko's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Igor Lizogubenko enrolled in Medicare?

Yes. Igor Lizogubenko is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Igor Lizogubenko was last updated on January 16, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.