JACLYN ROBERTS MD NPI 1922006238

NPI Information

NPI: 1922006238
Provider Name: JACLYN ROBERTS, MD
Classification: Specialist - 174400000X
Entity Type: Individual
Organization: MMC OB GYN PERINATAL DIAGNOSTIC ULTRASSOUND

PECOS Registration: Yes

Address:
5014 FORT HAMILTON PKWY
BROOKLYN, NY
ZIP 11219
Phone: (718) 283-8965
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Jaclyn Roberts, MD is a specialist in Brooklyn, NY with 33 years of experience. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. Jaclyn Roberts, MD NPI is 1922006238. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: STATE UNIVERSITY OF NEW YORK DOWNSTATE MEDICAL CENTER
Graduation Year:1991

The provider's business location address is:

5014 FORT HAMILTON PKWY
BROOKLYN, NY
ZIP 11219-324
Phone: (718) 283-8965
Fax: (718) 635-8977

The NPI 1922006238 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/11/2005 and was last updated on 1/22/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		191880-1	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	01873418	MEDICAID	NEW YORK
2	240532	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK
3	G54642	MEDICARE UPIN	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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