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WALLIE KANISHKA PHYSICIAN ASSISTANT
NPI 1659045235
Student in an Organized Health Care Education/Training Program in Glen Cove, NY

Active since August 05, 2021PECOS Enrolled
25 HITCHING POST LN, GLEN COVE, NY 11542(801) 918-4155 Get Directions Write a Review

NPPES record last updated: August 5, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Wallie Kanishka Physician Assistant NPPES

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

WALLIE KANISHKA PHYSICIAN ASSISTANT (NPI 1659045235) is an individual student in an organized health care education/training program in Glen Cove, New York and active in the NPI registry since August 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1659045235
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameWALLIE KANISHKACredential: PHYSICIAN ASSISTANT
Location Address25 HITCHING POST LNGlen Cove, NY 11542-1625
Mailing Address25 Hitching Post LnGlen Cove, NY 11542-1625 · (801) 918-4155
Phone(801) 918-4155
Sole ProprietorYes
Enumeration DateAugust 5, 2021
NPPES CertifiedAugust 5, 2021
✔ NPI 1659045235 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
25 HITCHING POST LN, Glen Cove, NY 11542
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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)

Wallie Kanishka Physician Assistant 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 Wallie Kanishka's NPI number?

The NPI number for Wallie Kanishka is 1659045235. It was assigned to this individual provider in the NPPES registry on August 5, 2021.

Where is Wallie Kanishka located?

Wallie Kanishka practices at 25 Hitching Post Ln, Glen Cove, NY 11542. The listed phone number is (801) 918-4155.

What is Wallie Kanishka's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Wallie Kanishka enrolled in Medicare?

Yes. Wallie Kanishka is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Wallie Kanishka was last updated on August 5, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.