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GENNADIY SHAMALOV PA
NPI 1174670319
Physician Assistant - Surgical in Briarwood, NY

Active since January 03, 2007PECOS Enrolled
141-23 HOOVER AVE, BRIARWOOD, NY 11435(917) 709-4733 Get Directions Write a Review

NPPES record last updated: September 25, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Gennadiy Shamalov Pa NPPES

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

GENNADIY SHAMALOV PA (NPI 1174670319) is an individual surgical provider in Briarwood, New York, licensed in New York (008219-1) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174670319
Entity TypeIndividualMale
Primary Taxonomy363AS0400X
Provider Legal NameGENNADIY SHAMALOVCredential: PA
Location Address141-23 HOOVER AVEBriarwood, NY 11435-1604
Mailing Address141-23 Hoover AveBriarwood, NY 11435-2930 · (917) 709-4733 · Fax (718) 559-4895
Phone(917) 709-4733
Sole ProprietorYes
Enumeration DateJanuary 3, 2007
Last NPPES UpdateSeptember 25, 2012
✔ NPI 1174670319 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in NY · 008219-1
141-23 HOOVER AVE, Briarwood, NY 11435
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Other Identifiers 1

Medicare UPINP65628NY

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gennadiy Shamalov Pa 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.

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 Gennadiy Shamalov's NPI number?

The NPI number for Gennadiy Shamalov is 1174670319. It was assigned to this individual provider in the NPPES registry on January 3, 2007.

Where is Gennadiy Shamalov located?

Gennadiy Shamalov practices at 141-23 Hoover Ave, Briarwood, NY 11435. The listed phone number is (917) 709-4733.

What is Gennadiy Shamalov's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Gennadiy Shamalov enrolled in Medicare?

Yes. Gennadiy Shamalov is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Gennadiy Shamalov was last updated on September 25, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.