Active NPI
Jacob David Ibey, ATC
- Athletic Trainer
- Enfield, CT
National Provider Identifier
1124123872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 000021
- Practice address
- 3 Weymouth Rd
Enfield, CT 06082 - Phone
- (860) 763-7625
- Fax
- (860) 272-2912
- NPI assigned
- Sep 14, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 000021 | CT | Primary |
Addresses
Primary practice location
3 Weymouth Rd
Enfield, CT 06082
Mailing address
58 Giddings Ave
Windsor, CT 06095-3702
Phone (860) 687-1459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000021 | CT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124123872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58 GIDDINGS AVE",
"city": "WINDSOR",
"state": "CT",
"postal_code": "060953702",
"telephone_number": "860-687-1459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 WEYMOUTH RD",
"city": "ENFIELD",
"state": "CT",
"postal_code": "06082",
"telephone_number": "860-763-7625",
"fax_number": "860-272-2912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBEY",
"first_name": "JACOB",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CT",
"license": "000021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Enfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.