JACK PHILIP TOM M.D.
NPI 1093724239
Dermatology in Stony Brook, NY

Active since August 05, 2006PECOS Enrolled
207 HALLOCK RD, SUITE 211, STONY BROOK, NY 11790(631) 444-0004(631) 444-0088 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jack Philip Tom M.d. NPPES

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

JACK PHILIP TOM M.D. (NPI 1093724239) is an individual dermatology provider in Stony Brook, New York, licensed in New York (155342) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1093724239
Entity TypeIndividualMale
Primary Taxonomy207N00000X
Provider Legal NameJACK PHILIP TOMCredential: M.D.
Location Address207 HALLOCK RD, SUITE 211Stony Brook, NY 11790-3033
Mailing Address207 Hallock Rd, Suite 211Stony Brook, NY 11790-3033 · (631) 444-0004 · Fax (631) 444-0088
Fax(631) 444-0088
Sole ProprietorYes
Enumeration DateAugust 5, 2006
Last NPPES UpdateJuly 8, 2007
NPI 1093724239 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in NY · 155342
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
207 HALLOCK RD, Stony Brook, NY 11790

Other Identifiers 3

Medicaid01711760NY
Medicare UPINA63692NY
Medicare ID-Type Unspecified66D74NY

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Jack Philip Tom M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11790 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

Registered Nurse
207 HALLOCK RD, SUITE 201
STONY BROOK, NY 11790
Audiologist-Hearing Aid Fitter
207 HALLOCK RD, SUITE 208
STONY BROOK, NY 11790
Speech-Language Pathologist
207 HALLOCK RD, SUITE 6
STONY BROOK, NY 11790
Community Health Worker
207 HALLOCK RD, SUITE 201
STONY BROOK, NY 11790
Speech-Language Pathologist
207 HALLOCK RD
STONY BROOK, NY 11790
Home Health
207 HALLOCK RD
STONY BROOK, NY 11790
Pediatrics
207 HALLOCK RD
STONY BROOK, NY 11790
Registered Nurse
207 HALLOCK RD
STONY BROOK, NY 11790

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 Jack Tom's NPI number?

The NPI number for Jack Tom is 1093724239. It was assigned to this individual provider in the NPPES registry on August 5, 2006.

Where is Jack Tom located?

Jack Tom practices at 207 Hallock Rd Suite 211, Stony Brook, NY 11790. The listed phone number is (631) 444-0004.

What is Jack Tom's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Jack Tom enrolled in Medicare?

Yes. Jack Tom is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jack Tom was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.