New York State Neuropsychological State of Mind PC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

016117 Issued in NY

Legal business name

NEW YORK STATE NEUROPSYCHOLOGICAL STATE OF MIND PC

Practice address

8460 123Rd St
Kew Gardens, NY 11415-3305

Phone

(718) 441-0166

Fax

(718) 805-2054

NPI assigned

Apr 9, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sanam Hafeez

Title

Psy.D

Phone

(718) 441-0166

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523232000000",
    "number": "1013414705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8460 123RD ST",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114153305",
            "telephone_number": "718-441-0166",
            "fax_number": "718-805-2054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8460 123RD ST",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114153305",
            "telephone_number": "718-441-0166",
            "fax_number": "718-805-2054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK STATE NEUROPSYCHOLOGICAL STATE OF MIND PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-09",
        "last_updated": "2018-04-09",
        "status": "A",
        "authorized_official_last_name": "HAFEEZ",
        "authorized_official_first_name": "SANAM",
        "authorized_official_title_or_position": "PSY.D",
        "authorized_official_telephone_number": "718-441-0166"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "016117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02936607",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ariel Nektalov
• Mojgan Neman-Kuighadush, M.D.
• New Homestead Home for Adults Inc
• New York Medical & Diagnostic Center Inc
• New York Medical and Diagnostic Center
• Beverly Nichols
• Jessica Karoline Nikiforidis, M.A., CCC-SLP
• Aleksandr Niyazov
• Peter R Niyazov, PHARMD
• Noah D Freedman MD PC

• Clinical Neuropsychologist in Kew Gardens, NY
• Providers in Kew Gardens, NY by specialty
• Clinical Neuropsychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.