Individual provider Active NPI

Jeneba Maibata, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • White Plains, NY
National Provider Identifier
1013553452
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F40449401 Issued in NY
Practice address
21 Bloomingdale Rd
White Plains, NY 10605-1504
Phone
(914) 682-9100
NPI assigned
Nov 20, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 666625 NY
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X F40449401 NY Primary

Addresses

Primary practice location

21 Bloomingdale Rd
White Plains, NY 10605-1504

Mailing address

21 Bloomingdale Rd
White Plains, NY 10605-1504
Phone (347) 207-7960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240918004511 NY Practitioner - Nurse Practitioner 7113468018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York City Health and Hospitals CorporationGroup PAC ID 4183535305, 543 clinicians

Practice addresses (Care Compare)

234 E 149 St
Bronx, NY 10451-5504
Phone (718) 579-5000

594 Albany Ave
Brooklyn, NY 11203-1706
Phone (646) 694-6680

Hospital & facility affiliations

  • Lincoln Medical & Mental Health Center Hospital, Bronx, NY, CCN 330080

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
666625NYMDRegistered Nurse
F40449401NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York City Health and Hospitals Corporation Single Specialty CurrentSince Aug 5, 2024 Accepting new patients
New York City Health and Hospitals Corporation Single Specialty Current Accepting new patients
New York City Health and Hospitals Corporation Single Specialty CurrentSince Aug 5, 2024 Accepting new patients

Locations

234 E 149th St
Rm 8D200
Bronx, NY 10451

594 Albany Ave
Brooklyn, NY 11203
Phone (646) 694-6680

50 Water St
Fl 3
New York, NY 10004

Networks

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

Organizations & group practices 3

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

Hospital & facility affiliations 1

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": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1013553452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 BLOOMINGDALE RD",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051504",
            "telephone_number": "347-207-7960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 BLOOMINGDALE RD",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051504",
            "telephone_number": "914-682-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIBATA",
        "first_name": "JENEBA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-20",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "666625",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F40449401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Plains, NY

Sources for this page

Verify at the official NPI Registry.