Menachem Jacobs
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · New Haven, CT
NPI 1316799240 · NPPES record last updated Jun 21, 2024
Key facts
- NPI
- 1316799240
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 20 York St
New Haven, CT 06510-3220 - Phone
- (203) 688-4242
- NPI assigned
- Apr 3, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240627003341 | CT | Order and Referring Only - Internal Medicine |
7214471556 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Interoperability endpoints
- mjacobs658830@direct.ynhh.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 78402 | CT | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
20 York St
New Haven, CT 06510-3220
Mailing address
20 York St
New Haven, CT 06510-3220
Phone (203) 688-4242
Other providers in New Haven, CT
- Van Rieves Jackson IV
- Andrea Jacobs-Stannard
- Harris C Jacobs
- Lauren Ashley Jacobs
- Mark Jacobs
- Richard A Jacobs
- Selby C Jacobs
- Leslie Jacobsen
- Ashley Ann Jacobson
- Christina Anne Jacobson
All providers in New Haven, CT · Student in an Organized Health Care Education/Training Program in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.