DR. GLENN W. JELKS M.D.
NPI 1043362957
Specialist in New York, NY

Q: What is Glenn Jelks's NPI number?

The NPI number for Glenn Jelks is 1043362957. It was assigned to this individual provider in the NPPES registry on January 18, 2007.

Q: What is Glenn Jelks's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Q: Is Glenn Jelks enrolled in Medicare?

No. Glenn Jelks has opted out of Medicare through June 18, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Glenn Jelks was last updated on February 8, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 18, 2007Opted out of Medicare · through Jun 18, 2028

875 PARK AVE, NEW YORK, NY 10075(212) 988-3303(212) 988-7984 Get Directions Write a Review

NPPES record last updated: February 8, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Glenn W. Jelks M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GLENN W. JELKS M.D. (NPI 1043362957) is an individual specialist in New York, New York, licensed in New York (134137) and active in the NPI registry since January 2007. He has opted out of Medicare through June 18, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1043362957

Entity TypeIndividualMale

Primary Taxonomy174400000X

Provider Legal NameDR. GLENN W. JELKSCredential: M.D.

Location Address875 PARK AVENew York, NY 10075-0382

Mailing Address875 Park AveNew York, NY 10075-0382 · (212) 988-3303 · Fax (212) 988-7984

Phone(212) 988-3303

Fax(212) 988-7984

Sole ProprietorNo

Enumeration DateJanuary 18, 2007

Last NPPES UpdateFebruary 8, 2010

✔ NPI 1043362957 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in NY · 134137

Definition

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.

875 PARK AVE, New York, NY 10075

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Other Identifiers 1

Medicare UPINB13896NY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Glenn W. Jelks M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 18, 2014 through June 18, 2028.

Opt-Out Effective DateJune 18, 2014

Opt-Out In Effect ThroughJune 18, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. BERNICE WONG D.M.D.

Dentist (General Practice)

875 PARK AVE, SUITE 1E
NEW YORK, NY 10075

New York County (347) 751-3053

PARK AVENUE MEDICAL SUITE

Clinic/Center (Ambulatory Surgical)

875 PARK AVE, SUITE 1F
NEW YORK, NY 10075

New York County (212) 792-6378

BERAKA MD PLASTIC SURGERY PLLC

Plastic Surgery

875 PARK AVE
NEW YORK, NY 10075

New York County (212) 288-1122

STEPHEN M. WARREN, MD, PC

Plastic Surgery

875 PARK AVE, SUITE 1F
NEW YORK, NY 10075

New York County (212) 447-6229

STEPHEN WARREN M.D.

Plastic Surgery

875 PARK AVE, SUITE 1F
NEW YORK, NY 10075

New York County (212) 447-6229

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Glenn Jelks's NPI number?

The NPI number for Glenn Jelks is 1043362957. It was assigned to this individual provider in the NPPES registry on January 18, 2007.

Where is Glenn Jelks located?

Glenn Jelks practices at 875 Park Ave, New York, NY 10075. The listed phone number is (212) 988-3303.

What is Glenn Jelks's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Glenn Jelks enrolled in Medicare?

No. Glenn Jelks has opted out of Medicare through June 18, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Glenn Jelks was last updated on February 8, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.