Active NPI
Jessica Lauren Stack, MD
- Psychiatry Physician
- New York, NY
National Provider Identifier
1619107331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- LP01739
- Practice address
- 138 W 25TH St FL 10
New York, NY 10001-7470 - Phone
- (212) 335-2100
- Fax
- (646) 775-4142
- NPI assigned
- Jul 15, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | LP01739 | RI | Primary |
Addresses
Primary practice location
138 W 25TH St FL 10
New York, NY 10001-7470
Mailing address
138 W 25TH St FL 10
New York, NY 10001-7470
Phone (212) 335-2100
Medicare participation
Medicare enrollment files- 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: Yes
- Opted out of Medicare
- Yes, effective Jul 6, 2015 through Jul 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP01739 | RI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612310400000",
"number": "1619107331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 W 25TH ST FL 10",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100017470",
"telephone_number": "212-335-2100",
"fax_number": "646-775-4142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 W 25TH ST FL 10",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100017470",
"telephone_number": "212-335-2100",
"fax_number": "646-775-4142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACK",
"first_name": "JESSICA",
"middle_name": "LAUREN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-15",
"last_updated": "2021-02-03",
"certification_date": "2021-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "RI",
"license": "LP01739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.