Active NPI
Jacqueline Chantal Nicolich, RPA-C
- Surgical Physician Assistant
- Southampton, NY
National Provider Identifier
1346780046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 020637
- Practice address
- Meeting House Lane Medical Practice, PC Surgical Spec.
240
Southampton, NY 11968 - Phone
- (631) 726-8717
- Fax
- (631) 726-8720
- NPI assigned
- Feb 28, 2017
- Last updated
- Apr 21, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 020637 | NY | Primary |
Addresses
Primary practice location
Meeting House Lane Medical Practice, PC Surgical Spec.
240
Southampton, NY 11968
Mailing address
4 Springville Rd Ste B
Hampton Bays, NY 11946-2290
Phone (631) 726-8717
Other names 1
- Jacqueline Chantal Rosante
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
240 Meeting House LN
Southampton, NY 11968-5009
Phone (631) 726-8400
325 Meeting House LN
Southampton, NY 11968-7000
3330 Noyac Rd
Sag Harbor, NY 11963-1930
Phone (631) 725-2112
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020637 | NY | MD | Surgical Physician Assistant |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Interoperability endpoints
- jacqueline.nicolich.p1@direct.shproviders.nextgenshare.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Southampton, NY
- NPI 1902088495
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Stony Brook Southampton Hospital
- General Acute Care Hospital
- Southampton, NY
- NPI 1033224704
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1225507114
-
- General Acute Care Hospital
- Greenport, NY
- NPI 1881690691
-
- General Acute Care Hospital
- Stony Brook, NY
- NPI 1972523348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745193600000",
"number": "1346780046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 SPRINGVILLE RD STE B",
"city": "HAMPTON BAYS",
"state": "NY",
"postal_code": "119462290",
"telephone_number": "631-726-8717",
"fax_number": "631-726-8720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MEETING HOUSE LANE MEDICAL PRACTICE, PC SURGICAL SPEC.",
"address_2": "240",
"city": "SOUTHAMPTON",
"state": "NY",
"postal_code": "11968",
"telephone_number": "631-726-8717",
"fax_number": "631-726-8720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLICH",
"first_name": "JACQUELINE",
"middle_name": "CHANTAL",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-28",
"last_updated": "2025-04-21",
"certification_date": "2025-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NY",
"license": "020637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACQUELINE",
"last_name": "ROSANTE",
"middle_name": "CHANTAL",
"credential": "RPA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Southampton, NY
- Sara Nardi, PA
- Kristin Patrick Naso, D.O.
- John Christopher Neill, PHD
- Richard C Nesi, DDS
- New York Society for the Relief of Ruptured & Crippled Maintaining (HSS Southampton)
- Hormuz Nicolwala, M.D.
- Diana Francis Nielsen, PTA
- Albert Noniyev, D.O
- North Sea Associates LLC (The Hamptons Center for Rehabilitation and Nursing)
- North Shore Hematology/Oncology Associates PC (NY Cancer & Blood Specialists)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.