Pjacoby, LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

0198781 Issued in CT

Legal business name

PJACOBY, LLC

Practice address

167 Sprain Brook Rd
Woodbury, CT 06798-1914

Phone

(203) 709-6079

NPI assigned

Dec 7, 2012

Organization subpart

No

Name

Dr. Peter Jacoby, MDNPI 1457377228

Title

Sole Member

Phone

(203) 709-6079

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter James Jacoby, MD

  • Emergency Medicine Physician
  • Waterbury, CT
  • NPI 1457377228

  CT, Emergency Medicine

  Medicare reassignment NPD Authorized official

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 21, 2015.

{
    "created_epoch": "1354838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429574400000",
    "number": "1912242520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 SPRAIN BROOK RD",
            "city": "WOODBURY",
            "state": "CT",
            "postal_code": "067981914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 SPRAIN BROOK RD",
            "city": "WOODBURY",
            "state": "CT",
            "postal_code": "067981914",
            "telephone_number": "203-709-6079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PJACOBY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-07",
        "last_updated": "2015-04-21",
        "status": "A",
        "authorized_official_last_name": "JACOBY",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "203-709-6079",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "0198781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy O'Keeffe Sr., LADC
• Rheagan Osteen, LMFT-A
• Margaret A Owens, MSPT
• Jennifer Pagnamenta, RPT
• Jill Papanek, LCSW
• Porter & Girgasky, Inc.
• Steven Prasinos, PH.D.
• Premier Care of Woodbury
• Regional School District #14
• Estella Reinhardt

• All providers in Woodbury, CT
• Emergency Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.