Individual provider Active NPI

Jessy Lukose

  • Gerontology Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1083931356
Registry record updated Apr 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
F340702-1 Issued in NY
Practice address
2601 Ocean Pkwy
Suite 4N98
Brooklyn, NY 11235-7745
Phone
(718) 616-3780
Fax
(718) 616-3797
NPI assigned
Apr 27, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X F340702-1 NY Primary

Addresses

Primary practice location

2601 Ocean Pkwy
Suite 4N98
Brooklyn, NY 11235-7745

Mailing address

148 Byrne Ave
PH
Staten Island, NY 10314-4407
Phone (718) 494-1874

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
I20220428002008 NY Practitioner - Nurse Practitioner 9638566292 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F340702-1NYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MJHS Medical Associates CurrentSince Apr 19, 2022 Accepting new patients

Locations

55 Water St
Fl 46
New York, NY 10041
Phone (212) 440-1943

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1272326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272326400000",
    "number": "1083931356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 BYRNE AVE",
            "address_2": "PH",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103144407",
            "telephone_number": "718-494-1874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 OCEAN PKWY",
            "address_2": "SUITE 4N98",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357745",
            "telephone_number": "718-616-3780",
            "fax_number": "718-616-3797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUKOSE",
        "first_name": "JESSY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-27",
        "last_updated": "2010-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "F340702-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.