Active NPI
Brian Jacob, MD
- Surgery Physician
- New York, NY
National Provider Identifier
1023084779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 219514
- Practice address
- 1010 5TH Ave
Laparoscopic Surgical Center
New York, NY 10028-0130 - Phone
- (212) 879-6677
- Fax
- (212) 650-9981
- NPI assigned
- Feb 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 219514 | NY | Primary |
Addresses
Primary practice location
1010 5TH Ave
Laparoscopic Surgical Center
New York, NY 10028-0130
Mailing address
1010 5TH Ave
Laparoscopic Surgery Center
New York, NY 10028-0130
Phone (212) 879-6677
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02588205 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2014 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 219514 | NY | MD | Nursing Care Agency |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Roosevelt Hospital Center | Past | Accepting new patients | |
| Mount Sinai School of Medicine | Surgery | Past | Accepting new patients |
| Mount Sinai Hospital | Past | Accepting new patients | |
| Mount Sinai Hospital | Past | Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 5
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.
-
- General Acute Care Hospital
- Long Island City, NY
- NPI 1245248939
-
- General Acute Care Hospital
- New York, NY
- NPI 1932103413
-
- General Acute Care Hospital
- New York, NY
- NPI 1104982917
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023084779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 5TH AVE",
"address_2": "LAPAROSCOPIC SURGERY CENTER",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100280130",
"telephone_number": "212-879-6677",
"fax_number": "212-650-9981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 5TH AVE",
"address_2": "LAPAROSCOPIC SURGICAL CENTER",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100280130",
"telephone_number": "212-879-6677",
"fax_number": "212-650-9981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "BRIAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "219514",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02588205",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.