Kelvin Karibo Jack, M.D

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

272090 Issued in NY

Practice address

407 Rockaway Ave FL 3
Brooklyn, NY 11212-5635

Phone

(718) 644-0961

NPI assigned

Mar 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Womens OB GYN Care at the Pavilion PC

  • Obstetrics & Gynecology Physician
  • Bronx, NY
  • NPI 1376594663
  NPD (past)

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1659332708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 FENTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104692801",
            "telephone_number": "718-644-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 ROCKAWAY AVE FL 3",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112125635",
            "telephone_number": "718-644-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "KELVIN",
        "middle_name": "KARIBO",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "272090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1316289853",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jack I. Apelbaum, M.D., P.L.L.C.
• Jack Jedwab MD PC
• Gail Jack-Mason
• Lystra Jack-Tosssaint, LPN
• Gweneth Kaycita Jack
• Lesleen A Jack
• Natasha Jack, LPN
• Oveta B Jack, RN
• Patricia Jack
• Prethadawn Jack

• Gynecology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; 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.