Individual provider Active NPI

Jennifer Doolan, NP

  • Adult Health Nurse Practitioner
  • East Setauket, NY
National Provider Identifier
1346339744
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F3040001 Issued in NY
Practice address
12 Brewster LN
East Setauket, NY 11733-2922
Phone
(631) 941-4480
Fax
(631) 941-4054
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F3040001 NY Primary

Addresses

Primary practice location

12 Brewster LN
East Setauket, NY 11733-2922

Mailing address

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 474-6351

Other identifiers 1

IdentifierTypeStateIssuer
F3040001OtherNYLICENSE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050723000127 NY Practitioner - Nurse Practitioner 1557398351 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F3040001NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
John T. Mather Memorial Hospital CurrentSince Jan 14, 2019 Accepting new patients
John T Mather Memorial Hospital Current Accepting new patients
John T. Mather Memorial Hospital CurrentSince Jan 14, 2019 Accepting new patients
John T. Mather Memorial Hospital Current Accepting new patients
John T. Mather Memorial Hospital Current Accepting new patients
John T Mather Memorial Hospital Current Accepting new patients
Harbor View Medical Services PC Past Accepting new patients

Locations

125 Oakland Ave
Ste 204
Port Jefferson, NY 11777
Phone (631) 686-1414

100 Highlands Blvd
#9
Port Jefferson, NY 11777
Phone (631) 686-7809

1500 Route 112
Ste A
Port Jefferson Station, NY 11776
Phone (631) 331-1120

70 N Country Rd
Ste 101
Prt Jefferson, NY 11777
Phone (631) 473-0037

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320

Interoperability endpoints

  • Direct secure messaging: jenniferdoolan@nslijmedgr.allscriptsdirect.net

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1346339744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 BREWSTER LN",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117332922",
            "telephone_number": "631-941-4480",
            "fax_number": "631-941-4054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOOLAN",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F3040001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "F3040001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.