Individual provider Active NPI

Jacqueline K Anto, FNP

  • Family Nurse Practitioner
  • New Hyde Park, NY
National Provider Identifier
1790057644
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
337106 Issued in NY
Practice address
410 Lakeville Rd
New Hyde Park, NY 11042-1101
Phone
(516) 465-5400
NPI assigned
Feb 7, 2012
Last updated
Feb 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 337106 NY Primary

Addresses

Primary practice location

410 Lakeville Rd
New Hyde Park, NY 11042-1101

Mailing address

117 Wright Rd
Rockville Centre, NY 11570-1239
Phone (516) 287-4238

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
I20180521002928 NY Practitioner - Nurse Practitioner 1951666023 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

410 Lakeville Rd
Suite 107
New Hyde Park, NY 11042-1102
Phone (516) 465-5400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
337106NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
Samaritan Medical Services, P.C. CurrentSince Jul 7, 2024 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients

Locations

340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064

300 Community Dr
Manhasset, NY 11030

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jacquelineanto@nslijmedgr.allscriptsdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1790057644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 WRIGHT RD",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115701239",
            "telephone_number": "516-287-4238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 LAKEVILLE RD",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421101",
            "telephone_number": "516-465-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTO",
        "first_name": "JACQUELINE",
        "middle_name": "K",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-07",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "337106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

Verify at the official NPI Registry.