Active NPI
Stethanie Ann Jacobs, PA-C
- Physician Assistant
- Brooklyn, NY
National Provider Identifier
1124208095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 012150-1
- Practice address
- 488 Midwood St
Apt. 6M
Brooklyn, NY 11225-4517 - Phone
- (908) 851-8691
- NPI assigned
- Nov 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 012150-1 | NY | Primary |
Addresses
Primary practice location
488 Midwood St
Apt. 6M
Brooklyn, NY 11225-4517
Mailing address
488 Midwood St
Apt. 6M
Brooklyn, NY 11225-4517
Phone (908) 851-8691
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012150-1 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194480000000",
"number": "1124208095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "488 MIDWOOD ST",
"address_2": "APT. 6M",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112254517",
"telephone_number": "908-851-8691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "488 MIDWOOD ST",
"address_2": "APT. 6M",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112254517",
"telephone_number": "908-851-8691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "STETHANIE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-08",
"last_updated": "2007-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "012150-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; 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.