Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Marykutty Jacob, ANP-C

Individual provider Adult Health Nurse Practitioner · NPI 1275836058

Marykutty Jacob, ANP-C is a Nurse Practitioner in New Hyde Park, New York. Qualified in 2009, 17 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
17
Licensed in
NY
In the registry since
2010
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Practice location Address checks out

450 Lakeville Rd Ste M41
New Hyde Park, NY 11042-1117
Phone: (516) 734-8500
Fax: (516) 734-8537
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence F 3055327-1 (NY)

Record details

NPI number1275836058
Entity typeIndividual (Type 1)
GenderFemale
Credentials ANP-C
Sole proprietorNo
NPI enumeratedDecember 16, 2010
Last updated in NPPESDecember 16, 2010

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in New Hyde Park