Jaclyn Teresco, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

017062 Issued in NY

Practice address

104 Forest Ave
Glen Cove, NY 11542-2015

Phone

(516) 759-5406

NPI assigned

Nov 4, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: primarycareoflongisland.jaclynteresco@157630.advancedmd-direct.com

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.

• Primary Urgent Medical PC

  • Internal Medicine Physician
  • Lindenhurst, NY
  • NPI 1700908605
  NPD (past)

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

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383523200000",
    "number": "1023447752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 FOREST AVE",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422015",
            "telephone_number": "516-759-5406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 FOREST AVE",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422015",
            "telephone_number": "516-759-5406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERESCO",
        "first_name": "JACLYN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-04",
        "last_updated": "2013-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "017062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malgorzata Szymanik, PT
• Esther Tambe, RD
• Mirza Tanovic, MD
• Bernard Tawfik
• Priscila Lorena Tenesaca I
• The Humanitarian Resource Foundation International Inc
• The Med Station PC
• Aimee Teresa Thomas
• Janine Thomesen, NP
• James Thompson, MD

• Medical Physician Assistant in Glen Cove, NY
• Providers in Glen Cove, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.