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COSMETIC SURGERY OF NEW YORK PC
NPI 1124229562
Specialist in Port Jefferson Station, NY

Active since May 31, 2007CLIA 33D2225039 · Waiver
4616 NESCONSET HWY, PORT JEFFERSON STATION, NY 11776(631) 473-7070(631) 331-2654 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Cosmetic Surgery Of New York Pc NPPES

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

COSMETIC SURGERY OF NEW YORK PC (NPI 1124229562) is a healthcare organization registered as a specialist in Port Jefferson Station, New York and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Robert Alan Jacobs, Surgeon, as its authorized official.

NPPES Registry Identity

NPI1124229562
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameCOSMETIC SURGERY OF NEW YORK PC
Location Address4616 NESCONSET HWYPort Jefferson Station, NY 11776-2563
Mailing Address4616 Nesconset HwyPort Jefferson Station, NY 11776-2563 · (631) 473-7070 · Fax (631) 331-2654
Phone(631) 473-7070
Fax(631) 331-2654
Organization SubpartNo
Authorized OfficialRobert Alan JacobsSurgeon · (631) 473-7070
Enumeration DateMay 31, 2007
Last NPPES UpdateJuly 21, 2022
✔ NPI 1124229562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
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.
4616 NESCONSET HWY, Port Jefferson Station, NY 11776
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Other Identifiers 1

OtherA400036602NY · Ptan

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cosmetic Surgery Of New York Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Cosmetic Surgery Of New York PC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Robert Jacobs, M.D.
Plastic and Reconstructive Surgery
NPI 1194810390
4616 NESCONSET HWY
Port Jefferson Station, NY 11776
(631) 473-7070
✔ PECOS✔ Accepts MedicareSame address
Hillard Warm, M.D.
Plastic and Reconstructive Surgery
NPI 1922150739
4616 NESCONSET HWY
Port Jefferson Station, NY 11776
(631) 473-7070
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2225039

Cosmetic Surgery Of New York PC · Port Jefferson Station, NY
Active · expires Mar 26, 2027
CLIA Number33D2225039
Laboratory TypePhysician Office
Certificate Effective DateMay 18, 2021
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Robert A. Jacobs
Laboratory Phone(631) 473-7070
Laboratory LocationCosmetic Surgery Of New York PC4616 Nesconset Highway, Port Jefferson Station, NY 11776
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Cosmetic Surgery Of New York PC's NPI number?

The NPI number for Cosmetic Surgery Of New York PC is 1124229562. It was assigned to this organization in the NPPES registry on May 31, 2007.

Where is Cosmetic Surgery Of New York PC located?

Cosmetic Surgery Of New York PC is located at 4616 Nesconset Hwy, Port Jefferson Station, NY 11776. The listed phone number is (631) 473-7070.

What is Cosmetic Surgery Of New York PC's specialty?

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

Is Cosmetic Surgery Of New York PC enrolled in Medicare?

Yes. Cosmetic Surgery Of New York PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Cosmetic Surgery Of New York PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Plastic and Reconstructive Surgery, reassign their Medicare billing to Cosmetic Surgery Of New York PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Cosmetic Surgery Of New York PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2225039) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Cosmetic Surgery Of New York PC was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.