Jessica Lauren Stack, MD
Psychiatry & Neurology, Psychiatry in New York, NY. Individual provider (NPI-1).
NPI number1619107331
StatusActive
Last updated in NPPESFeb 3, 2021
Details
- NPI
- 1619107331
- Entity type
- Individual (NPI-1)
- Name
- Jessica Lauren Stack
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 15, 2009
- Certification date
- Feb 3, 2021
- Last updated
- Feb 3, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- Medicare opt-out
- Jul 6, 2015 to Jul 6, 2027
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | LP01739 | RI | Yes |
Practice location
138 W 25th St Fl 10New York, NY 10001-7470
Phone 212-335-2100 · Fax 646-775-4142
Mailing address
138 W 25th St Fl 10New York, NY 10001-7470
Phone 212-335-2100 · Fax 646-775-4142
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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