Jacob Lackow, M.A.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

101 E 56TH St
New York, NY 10022-2661

Phone

(646) 625-4300

NPI assigned

Jul 15, 2016

Sex

Male

Sole proprietor

Yes

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

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: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1295188159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E 56TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100222661",
            "telephone_number": "646-625-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E 56TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100222661",
            "telephone_number": "646-625-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1339 20th St",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904042033",
            "country_code": "US",
            "telephone_number": "310-829-5511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACKOW",
        "first_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-15",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Rebecca Lack, DPT
• Judyta Otylia Lacka, MS
• Bryan Lackey, PMHNP-BC
• Roy S Lackey, MD
• Michael Joesph Lackner, P.A.
• Juliette Rose Lackow, LMSW
• Rachel Stephanie Lacks, ED.M.
• Noah Laclair
• Jessica B Lacorte, AUD
• Kenny Mikita Lacossiere, NURSE PRACTITIONER

• Student in an Organized Health Care Education/Training Program in New York, NY
• Providers in New York, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; 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.