Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Michelle Jack, PA-C

Individual provider Physician Assistant · NPI 1831631779

Michelle Jack, PA-C is a Physician Assistant in Stony Brook, New York. Qualified in 2016, 10 years ago. Practices with Peconic Bay Primary Medical Care, a 72-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New York.

Years since qualifying
10
Licensed in
NY
In the registry since
2016
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

Stony Brook Univ Hosp 101 Nicolls Road Hsc L-4 RM050
Stony Brook, NY 11794-4927
Phone: (631) 444-2478
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1000 Montauk Hwy, West Islip, NY 11795-4927 — (631) 376-3000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 020374 (NY)

Record details

NPI number1831631779
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedNovember 9, 2016
Last updated in NPPESJune 27, 2019

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Peconic Bay Primary Medical Care — 72 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Stony Brook