Active NPI
Jacob Bruno Dickstein
- Gastroenterology Physician
- Boston, MA
National Provider Identifier
1861756165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 253017
- Practice address
- 330 Brookline Ave
Stoneman 458
Boston, MA 02215-5400 - Phone
- (617) 667-0162
- NPI assigned
- Jul 2, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 253017 | MA | Primary |
Addresses
Primary practice location
330 Brookline Ave
Stoneman 458
Boston, MA 02215-5400
Mailing address
233 Winchester St
Brookline, MA 02446-2766
Phone (857) 225-4422
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 253017 | MA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341187200000",
"number": "1861756165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "233 WINCHESTER ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462766",
"telephone_number": "857-225-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 BROOKLINE AVE",
"address_2": "STONEMAN 458",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155400",
"telephone_number": "617-667-0162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKSTEIN",
"first_name": "JACOB",
"middle_name": "BRUNO",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-02",
"last_updated": "2012-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MA",
"license": "253017",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.