Dynamic Medical Services PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

197596 Issued in NY

Legal business name

DYNAMIC MEDICAL SERVICES PC

Practice address

25 Willet Ave
Hicksville, NY 11801-1637

Phone

(347) 744-8605

Fax

(516) 935-3140

NPI assigned

Jul 9, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Glenn Jorstad Jakobsen, DO

Title

Medical Director

Phone

(347) 744-8605

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531094400000",
    "number": "1174019681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 WILLET AVE",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118011637",
            "telephone_number": "347-744-8605",
            "fax_number": "516-935-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 WILLET AVE",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118011637",
            "telephone_number": "347-744-8605",
            "fax_number": "516-935-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC MEDICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-07-09",
        "status": "A",
        "authorized_official_last_name": "JAKOBSEN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "JORSTAD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "347-744-8605",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "197596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Hicksville, NY by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.