DR. JACK ANTHONY TESORIERO MD
NPI 1699424275
Student in an Organized Health Care Education/Training Program in Stony Brook, NY

Q: What is Jack Tesoriero's NPI number?

The NPI number for Jack Tesoriero is 1699424275. It was assigned to this individual provider in the NPPES registry on March 22, 2022.

Q: What is Jack Tesoriero's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Tesoriero was last updated on March 22, 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.

Active since March 22, 2022PECOS Enrolled

101 NICOLLS RD, STONY BROOK, NY 11794(631) 689-8333 Get Directions Write a Review

NPPES record last updated: March 22, 2022. Verified against the NPPES registry weekly; last sync: August 30, 2026.

On this page

About Dr. Jack Anthony Tesoriero Md NPPES

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

DR. JACK ANTHONY TESORIERO MD (NPI 1699424275) is an individual student in an organized health care education/training program in Stony Brook, New York and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1699424275

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameDR. JACK ANTHONY TESORIEROCredential: MD

Location Address101 NICOLLS RDStony Brook, NY 11794-0001

Mailing Address101 Nicolls RdStony Brook, NY 11794-0001 · (631) 689-8333

Phone(631) 689-8333

Sole ProprietorNo

Enumeration DateMarch 22, 2022

NPPES CertifiedMarch 22, 2022

✔ NPI 1699424275 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

101 NICOLLS RD, Stony Brook, NY 11794

Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jack Anthony Tesoriero Md 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.

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.

NARINDER SINGH M.D.

Internal Medicine