Active NPI
Jessica Wilk
- Family Nurse Practitioner
- New York, NY
National Provider Identifier
1356710222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F348338-01
- Practice address
- 1300 York Ave
New York, NY 10065-4805 - Phone
- (646) 697-0361
- Fax
- (646) 697-1005
- NPI assigned
- Sep 21, 2015
- Reactivated
- Jan 25, 2023
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F348338-01 | NY | Primary |
Addresses
Primary practice location
1300 York Ave
New York, NY 10065-4805
Mailing address
585 Standish Rd
Teaneck, NJ 07666-1817
Phone (917) 892-6654
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260527001158 | NY | Order and Referring Only - Nurse Practitioner | 0840760211 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F348338-01 | NY | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675209600000",
"number": "1356710222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "585 STANDISH RD",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076661817",
"telephone_number": "917-892-6654",
"fax_number": "877-537-5387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 YORK AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100654805",
"telephone_number": "646-697-0361",
"fax_number": "646-697-1005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILK",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-21",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"deactivation_date": "2023-01-18",
"reactivation_date": "2023-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "F348338-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; 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.