Jaclyn Kischkower, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

311866 Issued in NY

Practice address

45 Research Way Ste 108
East Setauket, NY 11733-6401

Phone

(631) 941-2000

Fax

(631) 941-2010

NPI assigned

Aug 8, 2024

Sex

Female

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

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles (2 of 6)

Locations

Networks

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stony Brook Internists, University Faculty Practice Corporation

  • Cardiac Rehabilitation Registered Nurse
  • Stony Brook, NY
  • NPI 1295778371
  Medicare reassignment NPD
• Stony Brook Internists, University Faculty Practice Corporation

  • Medical Oncology Physician
  • Stony Brook, NY
  • NPI 1184679342
  NPD (past)

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

{
    "created_epoch": "1723075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1306677620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 RESEARCH WAY STE 108",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117336401",
            "telephone_number": "631-941-2000",
            "fax_number": "631-941-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 RESEARCH WAY STE 108",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117336401",
            "telephone_number": "631-941-2000",
            "fax_number": "631-941-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISCHKOWER",
        "first_name": "JACLYN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-08",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "311866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asim S Khokhar, M.D.
• Tammie Kienzle
• Haksoo Kim, NURSE PRACTITIONER
• Sung Kwang Kim
• Mariam M Kirvalidze, DO
• Kim Kjaer
• Diane Klein-Ritter, M.D.
• Arthur S Klein, M.D.
• Stefanie Michelle Kleinberg, PA-C
• Katarzyna Klek, MD

• Nurse Practitioner in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.