Individual provider Active NPI

Robert Jackson, FNP

  • Family Nurse Practitioner
  • Eastchester, NY
National Provider Identifier
1396834990
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F331987 Issued in NY
Practice address
375 White Plains Rd
Eastchester, NY 10709-2826
Phone
(866) 389-2727
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F331987 NY Primary

Addresses

Primary practice location

375 White Plains Rd
Eastchester, NY 10709-2826

Mailing address

375 White Plains Rd
Eastchester, NY 10709-2826
Phone (866) 389-2727

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
I20071017000384 NY Practitioner - Nurse Practitioner 9537255955 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
331987NYMDInfectious Disease Physician
F331987NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Sep 10, 2007 Accepting new patients
Medical Group of New York, P.C. Family CurrentSince Jan 10, 2025 Accepting new patients
Matrix Medical of New York PC Nurse Practitioner CurrentSince Oct 1, 2025 Accepting new patients
Montefiore Medical Center CurrentSince Sep 10, 2007 Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

107 S Country Rd
Bellport, NY 11713
Phone (631) 286-2222

111 E 210th St
Bronx, NY 10467

853 Longwood Ave
Bronx, NY 10459
Phone (718) 588-4460

1055 E Tremont Ave
Bronx, NY 10460
Phone (718) 842-8040

375 White Plains Rd
Eastchester, NY 10709
Phone (914) 337-5300

7960 Metropolitan Ave
Middle Village, NY 11379
Phone (718) 326-4910

1740 Broadway
Fl 15
New York, NY 10019
Phone (201) 256-5032

424 Church St
Ste 2600
Nashville, TN 37219
Phone (480) 450-3721

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 5

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": "1735776000000",
    "number": "1396834990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 WHITE PLAINS RD",
            "city": "EASTCHESTER",
            "state": "NY",
            "postal_code": "107092826",
            "telephone_number": "866-389-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 WHITE PLAINS RD",
            "city": "EASTCHESTER",
            "state": "NY",
            "postal_code": "107092826",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F331987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastchester, NY

Sources for this page

Verify at the official NPI Registry.