Individual provider Active NPI

Deepa Jose, NP

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1104103076
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
30 305733 Issued in NY
Practice address
535 East 70TH St
New York, NY 10021
Phone
(212) 606-1000
NPI assigned
Nov 7, 2011
Last updated
Apr 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 30 305733 NY Primary
Gerontology Nurse Practitioner 363LG0600X 34 340816 NY

Addresses

Primary practice location

535 East 70TH St
New York, NY 10021

Mailing address

1 Rolling Ridge Rd
New City, NY 10956-6931
Phone (845) 638-0063

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
I20160421000652 NY Practitioner - Nurse Practitioner 8325201585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurosurgical Associates of New Jersey, P.C.Group PAC ID 2961405055, 42 clinicians

Practice addresses (Care Compare)

10 Waldron Ave
Nyack, NY 10960-2965
Phone (845) 288-2395

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
305733NYMDLicensed Practical Nurse
30 305733NYMDAdult Health Nurse Practitioner
34 340816NYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Pain Management, PC CurrentSince Mar 2, 2016 Accepting new patients
Neurosurgical Associates of New Jersey, P.C. CurrentSince Sep 27, 2023 Accepting new patients

Locations

1200 E Ridgewood Ave
Ste 200
Ridgewood, NJ 07450
Phone (201) 327-8600

118 N Bedford Rd
Ste 200
Mount Kisco, NY 10549
Phone (800) 362-6220

10 Waldron Ave
Nyack, NY 10960
Phone (845) 288-2395

160 N Midland Ave
Fl 5
Nyack, NY 10960
Phone (845) 348-2243

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461024000000",
    "number": "1104103076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ROLLING RIDGE RD",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "109566931",
            "telephone_number": "845-638-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 EAST 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10021",
            "telephone_number": "212-606-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOSE",
        "first_name": "DEEPA",
        "name_prefix": "Miss",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-07",
        "last_updated": "2016-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "30 305733",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "34 340816",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.