Tina Jacob, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

056792 Issued in NY

Practice address

5 Pine West PLZ Ste 504
Albany, NY 12205-5587

Phone

(518) 456-5134

NPI assigned

Jan 30, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• McMahon Family Dentistry, PLLC

  • Dentist
  • Albany, NY
  • NPI 1518020528
  NPD (past)

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

{
    "created_epoch": "1359504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1932447620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 PINE WEST PLZ STE 504",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055587",
            "telephone_number": "518-456-5134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PINE WEST PLZ STE 504",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055587",
            "telephone_number": "518-456-5134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "TINA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-30",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "056792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J. Logan NP in Psychiatry PLLC
• Esther Pearl Jackson, LMSW
• Stephanie Jackson
• Stephanie Chanelle Jackson, LPN
• Robin Jacob, RN
• Alon Brachya Jacobs-Friedman
• Apryl Jacobs, PHARMD
• Edward Julius Jacobs, M.D.
• Hugh F. Jacobs, M.D.
• James Jacobs

• General Practice Dentistry in Albany, NY
• Providers in Albany, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; 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.

Verify at the official NPI Registry.