Jacob Wallach, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

50 053926 Issued in NY

Practice address

99 N Broadway
Nyack, NY 10960-2627

Phone

(845) 358-1728

NPI assigned

Aug 1, 2008

Last updated

Aug 4, 2011By 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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1114183837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 N BROADWAY",
            "city": "NYACK",
            "state": "NY",
            "postal_code": "109602627",
            "telephone_number": "845-358-1728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 N BROADWAY",
            "city": "NYACK",
            "state": "NY",
            "postal_code": "109602627",
            "telephone_number": "845-358-1728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACH",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "50 053926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Belisa Vranich
• Jennifer Ann Wagner, NP
• Naji Abdul Wajid, D.O.
• Walgreen Co (Walgreens #13611)
• Robin J Wallace, LCSW-R
• Kristin Walsh
• Hilsa Walters-Pelham, P.A.
• Crissy L Wang, BCBA
• Matthew Jude Watson, O.D.
• Erin Yi Chen Wei, MD

• Dentist in Nyack, NY
• Providers in Nyack, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; 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.