Active NPI
Jeremy R Mack, MD
- Psychiatry Physician
- New York, NY
National Provider Identifier
1811048598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 100528
- Practice address
- Ten East 96TH St.
New York, NY 10128 - Phone
- (212) 987-2815
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 100528 | NY | Primary |
Addresses
Primary practice location
Ten East 96TH St.
New York, NY 10128
Mailing address
Ten East 96TH St.
New York, NY 10128
Phone (212) 987-2815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 29, 2021 through Mar 29, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811048598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "TEN EAST 96TH ST.",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10128",
"telephone_number": "212-987-2815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "TEN EAST 96TH ST.",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10128",
"telephone_number": "212-987-2815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "JEREMY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "100528",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.