Individual provider Active NPI

Mena Yacoub, D.O

  • Clinical Cardiac Electrophysiology Physician
  • Roslyn, NY
National Provider Identifier
1003223835
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
25MB00926100 Issued in NJ
Practice address
100 Port Washington Blvd
Roslyn, NY 11576-1347
Phone
(516) 562-6000
NPI assigned
Jul 14, 2014
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 306224 NY
Student in an Organized Health Care Education/Training Program 390200000X
Student in an Organized Health Care Education/Training Program 390200000X 640750326 NY
Clinical Cardiac Electrophysiology Physician 207RC0001X 25MB00926100 NJ Primary

Addresses

Primary practice location

100 Port Washington Blvd
Roslyn, NY 11576-1347

Mailing address

PO Box 192
Port Washington, NY 11050-0192

Other practice location 1

946 Bloomfield Ave
Glen Ridge, NJ 07028-1308
Phone (973) 743-1121

Other practice location 2

1111 Amsterdam Ave
New York, NY 10025-1716
Phone (212) 523-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220520002477 NJ Practitioner - Cardiovascular Disease (Cardiology) 0143607663 Reassigns benefits to 1 organization
I20221121001954 NY Practitioner - Cardiac ElectrophysiologyPractitioner - Internal MedicinePractitioner - Hospitalist 0143607663 Reassigns benefits to 3 organizations
Practice locations: Roslyn, NY

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

100 Port Washington Blvd
Roslyn, NY 11576-1347
Phone (516) 562-6000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair137

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
25MB00926100NJMDClinical Cardiac Electrophysiology Physician
306224NYMDHospitalist Physician
640750326NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Nov 1, 2022 Accepting new patients
CHS Physician Partners, P.C CurrentSince Dec 18, 2024 Accepting new patients
CHS Physician Partners, PC Current Accepting new patients
St. Francis Hospital CurrentSince May 2, 2025 Accepting new patients
St Francis Hospital United States Catholic Conference CurrentSince May 2, 2025 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Nov 1, 2022 Accepting new patients
St. Francis Hospital Current Accepting new patients
Medical Associates of Englewood, PC CurrentSince Jul 1, 2022 Accepting new patients
Joseph H. Levine, M.D., P.C. Clinical Cardiac Electrophysiology PastSince Aug 27, 2023 Accepting new patients

Locations

946 Bloomfield Ave
Glen Ridge, NJ 07028
Phone (973) 376-3259

24 Elm St
Ste 203
Harrington Pk, NJ 07640
Phone (201) 784-0123

30 Montgomery St
Ste 720
Jersey City, NJ 07302
Phone (212) 524-7766

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

1111 Amsterdam Ave
New York, NY 10025
Phone (212) 523-2309

17 E 102nd St
New York, NY 10029
Phone (212) 241-7968

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

100 Port Washington Blvd
Fl 2
Roslyn, NY 11576
Phone (516) 414-3222

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: myacoub152439@direct-chsli.net
  • Direct secure messaging: myacoub295421@direct.englewoodhealth.org
  • Direct secure messaging: myacoub576430@ahs.direct-ci.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1003223835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 192",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110500192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PORT WASHINGTON BLVD",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115761347",
            "telephone_number": "516-562-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "946 Bloomfield Ave",
            "address_purpose": "LOCATION",
            "city": "Glen Ridge",
            "state": "NJ",
            "postal_code": "070281308",
            "country_code": "US",
            "telephone_number": "973-743-1121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1111 Amsterdam Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100251716",
            "country_code": "US",
            "telephone_number": "212-523-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YACOUB",
        "first_name": "MENA",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-14",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "306224",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "640750326",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NJ",
            "license": "25MB00926100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslyn, NY

Sources for this page

Verify at the official NPI Registry.