Krystyna De Jacq, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

401238 Issued in NY

Practice address

709 Palmer CT Apt 2E
Mamaroneck, NY 10543-2442

Phone

(917) 513-0273

NPI assigned

Nov 20, 2009

Last updated

Apr 13, 2023By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Previously, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Mamaroneck NP in Psychiatry PLLC

  • Adult Mental Health Clinic/Center
  • Mamaroneck, NY
  • NPI 1376362590
  NPD Authorized official

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

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1568790152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 PALMER CT APT 2E",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105432442",
            "telephone_number": "917-513-0273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 PALMER CT APT 2E",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105432442",
            "telephone_number": "917-513-0273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE JACQ",
        "first_name": "KRYSTYNA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-20",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "401238",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "401238",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ayla A Dadasheva, NP
• Kyle Dailey
• Kerri-Ann Alisha Dalrymple
• David M. Fulop DC, P.C. (mamaroneck chiro)
• Deanna Davis
• Maria Luisa De la Morena, MD
• Henry De la Rosa
• Eve E Deitz, L.P.N.
• Alyssa Marie Del Negro, MS, CCC-SLP
• Julia Paige Deloach, MSN, FNP-BC

• Psychiatric/Mental Health Nurse Practitioner in Mamaroneck, NY
• Providers in Mamaroneck, 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 Apr 13, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.