Glenn W. Jelks, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

134137 Issued in NY

Practice address

875 Park Ave
New York, NY 10075-0382

Phone

(212) 988-3303

Fax

(212) 988-7984

NPI assigned

Jan 18, 2007

Last updated

Feb 8, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 18, 2014 through Jun 18, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: gjelks67991@northwell.direct-ci.com

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265587200000",
    "number": "1043362957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100750382",
            "telephone_number": "212-988-3303",
            "fax_number": "212-988-7984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100750382",
            "telephone_number": "212-988-3303",
            "fax_number": "212-988-7984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELKS",
        "first_name": "GLENN",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2010-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "134137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward James Jeklinski, DPT
• Svetlana Jelen, RN, ANP
• Sanja Jelic, M.D.
• Sophia Jelke, DDS, MD
• Elizabeth Brady Jelks, M.D.
• Jelksmedical, PLLC
• Roberta Jellinekmansson, PH.D.
• Alissa Lee Appel Jelveh, LCSW
• Neyra Mohammed Jemal
• Oyindamola Jemilawon, LMSW

• Specialist in New York, NY
• Providers in New York, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; 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.

Verify at the official NPI Registry.