MR. JACOB HENRY ETTINGER PA
NPI 1063441517
Physician Assistant - Surgical in Great Neck, NY
About Mr. Jacob Henry Ettinger Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. JACOB HENRY ETTINGER PA (NPI 1063441517) is an individual surgical provider in Great Neck, New York, licensed in New York (009528) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with North Shore University Hospital, and is a graduate of Other (2003).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mr. Jacob Henry Ettinger Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
North Shore University Hospital
Acute Care Hospitals · Manhasset, NYMedicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
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 Jacob Ettinger's NPI number?
The NPI number for Jacob Ettinger is 1063441517. It was assigned to this individual provider in the NPPES registry on June 30, 2006.
Where is Jacob Ettinger located?
Jacob Ettinger practices at 21 Canterbury Rd Apartment #3, Great Neck, NY 11021. The listed phone number is (516) 570-6015.
What is Jacob Ettinger's specialty?
The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.
Is Jacob Ettinger enrolled in Medicare?
Yes. Jacob Ettinger is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Is Jacob Ettinger affiliated with any hospitals?
According to CMS data, Jacob Ettinger is affiliated with North Shore University Hospital.
When was this NPI record last updated?
The NPPES record for Jacob Ettinger was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.
# Mr. Jacob Henry Ettinger, PA · NPI 1063441517
Surgical physician in Great Neck, New York. Individual provider, active in the CMS NPPES registry since June 30, 2006.
## Identity
- **NPI:** 1063441517 (Entity type: Individual)
- **Enumerated:** June 30, 2006
- **Primary specialty:** Physician Assistant - Surgical · taxonomy 363AS0400X
- **State license:** 009528 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 21 CANTERBURY RD, APARTMENT #3, Great Neck, NY 11021-2123
- **Phone:** (516) 570-6015
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2003
## Record status
- **NPPES last updated:** September 11, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1063441517) · Data from the CMS NPPES public registry.