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JACQUELINE VIDETTO PA-C
NPI 1083049480
Physician Assistant - Medical in Massapequa, NY

Active since September 05, 2013PECOS Enrolled
100 VETERANS BLVD STE 1, MASSAPEQUA, NY 11758(516) 882-9600(516) 882-9605 Get Directions Write a Review

NPPES record last updated: September 30, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jacqueline Videtto Pa-c NPPES

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

JACQUELINE VIDETTO PA-C (NPI 1083049480) is an individual medical provider in Massapequa, New York, licensed in New York (016854) and active in the NPI registry since September 2013. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1083049480
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameJACQUELINE VIDETTOCredential: PA-C
Location Address100 VETERANS BLVD STE 1Massapequa, NY 11758-4945
Mailing Address100 Veterans Blvd Ste 1Massapequa, NY 11758-4945 · (516) 882-9600 · Fax (516) 882-9605
Phone(516) 882-9600
Fax(516) 882-9605
Sole ProprietorNo
Enumeration DateSeptember 5, 2013
Last NPPES UpdateSeptember 30, 2025
NPPES CertifiedSeptember 30, 2025
✔ NPI 1083049480 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in NY · 016854
100 VETERANS BLVD STE 1, Massapequa, NY 11758
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline Videtto Pa-c 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.

Other Providers at the Same Location NPPES 2

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

CHRISTINE JOY LAPERSONERIE FNP-C
Nurse Practitioner (Family)
100 VETERANS BLVD STE 1
MASSAPEQUA, NY 11758
Nassau County (516) 882-9600
NINA MARIE PRAKOPE NP
Internal Medicine (Cardiovascular Disease)
100 VETERANS BLVD STE 1
MASSAPEQUA, NY 11758
Nassau County (516) 882-9600

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 Jacqueline Videtto's NPI number?

The NPI number for Jacqueline Videtto is 1083049480. It was assigned to this individual provider in the NPPES registry on September 5, 2013.

Where is Jacqueline Videtto located?

Jacqueline Videtto practices at 100 Veterans Blvd Ste 1, Massapequa, NY 11758. The listed phone number is (516) 882-9600.

What is Jacqueline Videtto's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Jacqueline Videtto enrolled in Medicare?

Yes. Jacqueline Videtto is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacqueline Videtto was last updated on September 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.