Active NPI
Warren W Jackson, RPA-C
- Physician Assistant
- Patchogue, NY
National Provider Identifier
1447328166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000191-1
- Practice address
- 101 Hospital Rd
Patchogue, NY 11772-4870 - Phone
- (631) 654-7236
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000191-1 | NY | Primary |
Addresses
Primary practice location
101 Hospital Rd
Patchogue, NY 11772-4870
Mailing address
300 Deep Hole Dr
Mattituck, NY 11952-2690
Phone (631) 298-3220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000191 | NY | MD | Metabolic Nutrition Registered Dietitian |
| 000191-1 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447328166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 DEEP HOLE DR",
"city": "MATTITUCK",
"state": "NY",
"postal_code": "119522690",
"telephone_number": "631-298-3220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 HOSPITAL RD",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117724870",
"telephone_number": "631-654-7236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "WARREN",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "000191-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.