Mark Aaron Jacknin, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

230171 Issued in NY

Practice address

4405 Broadway
New York, NY 10040-4014

Phone

(212) 740-2020

Fax

(646) 666-0280

NPI assigned

Mar 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 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

Specialty

Family PracticeAlso: Osteopathic Manipulative Medicine

Education

New York College of Osteo Medicine of New York Institute of Technology, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Griffin Myers Medical PCGroup PAC ID 5294145017, 78 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Networks

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

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.

• Griffin Myers Medical, P.C.

  • Primary Care Clinic/Center
  • Brooklyn, NY
  • NPI 1780209445

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Lakewood Resource and Referral Center Inc

  • Federally Qualified Health Center (FQHC)
  • Lakewood, NJ
  • NPI 1083748297
  Medicare reassignment NPD
• Lakewood Resource and Referral Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jackson, NJ
  • NPI 1124844816
  NPD
• Lakewood Resource and Referral Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lakewood, NJ
  • NPI 1518437474
  NPD

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1033179338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746087",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746087",
            "telephone_number": "312-733-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100404014",
            "telephone_number": "212-740-2020",
            "fax_number": "646-666-0280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "77 Boulevard",
            "address_purpose": "LOCATION",
            "city": "Passaic",
            "state": "NJ",
            "postal_code": "070554705",
            "country_code": "US",
            "telephone_number": "917-603-8862",
            "fax_number": "718-504-7521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKNIN",
        "first_name": "MARK",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "230171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02716663",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carl Jackman, LMSW
• Eileen V Jackman, LMSW
• Kasey B. Jackman, PHD, RN, PMHNP-BC
• Sophia Jackman, MD
• Clifton Jackness, MD
• Shelby Jackowitz
• Tia Jackson-Bey, MD
• Kamilyah Jackson-Cooper, LCSW
• Alexandra Jackson-Hernandez
• Claire Louise Jackson-Rabinowitz, D.O.

• Family Medicine Physician in New York, NY
• Providers in New York, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.