Mary Dale Jenkins, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

154307 Issued in NY

Practice address

366 N Broadway
Suite 305
Jericho, NY 11753-2025

Phone

(516) 935-7272

Fax

(516) 935-7282

NPI assigned

Dec 5, 2006

Sex

Female

Sole proprietor

No

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Optum Urgent Care, PLLC

  • Urgent Care Clinic/Center
  • Jericho, NY
  • NPI 1285975797
  Medicare reassignment NPD
• Physicians Care of Long Island

  • Specialist
  • Jericho, NY
  • NPI 1760609572
  NPD (past) Authorized official
• South Nassau Primary Medical Care PC

  • Multi-Specialty Clinic/Center
  • Bellmore, NY
  • NPI 1134119928
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207785600000",
    "number": "1316005895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 N BROADWAY",
            "address_2": "SUITE 305",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532025",
            "telephone_number": "516-935-7272",
            "fax_number": "516-935-7282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 N BROADWAY",
            "address_2": "SUITE 305",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532025",
            "telephone_number": "516-935-7272",
            "fax_number": "516-935-7282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "MARY",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2008-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "154307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irtaqua Jamil
• Naomi Jankowitz, LCSW
• Jason S. Applebaum, MD, PC
• Jay M. Weiss MD P.C.
• Yoonjin Jee, LCSW, CASAC
• Michelle Ahn Jeong
• Jericho Fire District
• Jericho Nephrology PLLC
• Jericho Orthodontics and Pediatric Dentistry
• Jericho Physical Therapy PC

• Family Medicine Physician in Jericho, NY
• Providers in Jericho, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; 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.