Active NPI
Jenna Ilyssa Meyers
- Physician Assistant
- New York, NY
National Provider Identifier
1801764998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 622 W 168TH St
New York, NY 10032-3720 - Phone
- (646) 745-6369
- NPI assigned
- Oct 29, 2025
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
622 W 168TH St
New York, NY 10032-3720
Mailing address
104 Breeley Blvd
Melville, NY 11747-5355
Phone (631) 609-7160
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260227003015 | NY | Order and Referring Only - Physician Assistant | 4183105042 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034451 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771891200000",
"number": "1801764998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 BREELEY BLVD",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117475355",
"telephone_number": "631-609-7160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 W 168TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323720",
"telephone_number": "646-745-6369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEYERS",
"first_name": "JENNA",
"middle_name": "ILYSSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-10-29",
"last_updated": "2026-02-24",
"certification_date": "2026-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"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 24, 2026; 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.