Individual provider Active NPI

Jacob Sjirk Saslow, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1760869408
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F403586 Issued in NY
Practice address
1045 James St
Syracuse, NY 13203-2730
Phone
(315) 530-2290
NPI assigned
May 1, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 008076-1 NY
Mental Health Counselor 101YM0800X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F403586 NY Primary

Addresses

Primary practice location

1045 James St
Syracuse, NY 13203-2730

Mailing address

1045 James St
Syracuse, NY 13203-2730
Phone (315) 530-2290

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210830001085 NY Practitioner - Nurse Practitioner 3577968536 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
008076-1NYMDCommunity Health Worker
F403586NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty Resources Inc. Current Accepting new patients
Liberty Resources, Inc. CurrentSince Aug 23, 2021 Accepting new patients
Liberty Resources, Inc. CurrentSince Aug 23, 2021 Accepting new patients

Locations

1045 James St
Syracuse, NY 13203
Phone (315) 425-1004

Interoperability endpoints

  • Direct secure messaging: jacob.saslow.p1@direct.liberty-resources.nextgenshare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1430438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1760869408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032730",
            "telephone_number": "315-530-2290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032730",
            "telephone_number": "315-530-2290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SASLOW",
        "first_name": "JACOB",
        "middle_name": "SJIRK",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-01",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "008076-1",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F403586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.