Active NPI
Mahima Jacob, M.D.
- Internal Medicine Physician
- Yonkers, NY
National Provider Identifier
1366442113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 230656
- Practice address
- 69 S Broadway
Yonkers, NY 10701-4004 - Phone
- (914) 376-5555
- Fax
- (914) 964-1477
- NPI assigned
- Jul 22, 2005
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 230656 | NY | Primary |
Addresses
Primary practice location
69 S Broadway
Yonkers, NY 10701-4004
Mailing address
69 S Broadway
Yonkers, NY 10701-4004
Phone (914) 376-5555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02619776 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 230656 | NY | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366442113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "69 S BROADWAY",
"city": "YONKERS",
"state": "NY",
"postal_code": "107014004",
"telephone_number": "914-376-5555",
"fax_number": "914-964-1477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "69 S BROADWAY",
"city": "YONKERS",
"state": "NY",
"postal_code": "107014004",
"telephone_number": "914-376-5555",
"fax_number": "914-964-1477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "MAHIMA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "230656",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02619776",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yonkers, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.