Jacob Thengampallil

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403172 Issued in NY

Practice address

140 Old Orangeburg Rd
Orangeburg, NY 10962-1157

Phone

(845) 680-8694

NPI assigned

May 1, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1447748843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 OLD ORANGEBURG RD",
            "city": "ORANGEBURG",
            "state": "NY",
            "postal_code": "109621157",
            "telephone_number": "845-680-8694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 OLD ORANGEBURG RD",
            "city": "ORANGEBURG",
            "state": "NY",
            "postal_code": "109621157",
            "telephone_number": "845-680-8694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THENGAMPALLIL",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-01",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "NY",
            "license": "592600",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mo Tavakkoli, MD, MPH, MSC
• Carmel Taylor
• Arlene Gadia Tayo, BSN
• Elena Marie Temple
• Abraham Thengampallil, M.D.
• Luby Thomas
• Madonna Thomas
• Shinu M Thomas
• Susan Thomas
• Maria Thomas Thottathil

• Psychiatric/Mental Health Nurse Practitioner in Orangeburg, NY
• Providers in Orangeburg, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; 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.

Verify at the official NPI Registry.