Judd Jacob, PT, CLS

Primary specialty

Clinical Laboratory Director (Non-physician)Taxonomy code 247ZC0005X

License

014999 Issued in NY

Practice address

340 S Broadway
Yonkers, NY 10705-2049

Phone

(914) 968-5125

Fax

(914) 968-5123

NPI assigned

Feb 10, 2011

Last updated

Apr 13, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Greater New York Physical Therapy and Chiropractic PLLC

  • Physical Therapist
  • White Plains, NY
  • NPI 1093094047
  NPD
• Genesis Medical Health PC

  • General Practice Physician
  • Spring Valley, NY
  • NPI 1295043099
  NPD (past)

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

{
    "created_epoch": "1297296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460505600000",
    "number": "1407152333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 GRAND ST",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106014803",
            "telephone_number": "914-328-8077",
            "fax_number": "914-328-6083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 S BROADWAY",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107052049",
            "telephone_number": "914-968-5125",
            "fax_number": "914-968-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JUDD",
        "credential": "PT, CLS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-10",
        "last_updated": "2016-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "032031",
            "primary": false
        },
        {
            "code": "247ZC0005X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
            "state": "NY",
            "license": "014999",
            "primary": true
        },
        {
            "code": "247ZC0005X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
            "state": "NU",
            "license": "226448",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Pamela Jackson, LPN
• Jacob Car Service Inc
• Anju H Jacob, PT
• Eldho Chacko Jacob
• Jenny Jacob, RPH
• Mahima Jacob, M.D.
• Nisha Ann Jacob, MD
• Jacobi Hospital
• Claudette Jacobs
• Jae Psychotherapy LCSW, PLLC (The JAE Practice)

• Clinical Laboratory Director (Non-physician) in Yonkers, NY
• Providers in Yonkers, NY by specialty
• Clinical Laboratory Director (Non-physician) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.