Active NPI
Myron Drazen, PHD
- Clinical Psychologist
- Stonybrook, NY
National Provider Identifier
1023028362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 006929
- Practice address
- 2500 Nesconset Hwy
BLDG 5D
Stonybrook, NY 11790 - Phone
- (631) 689-7979
- Fax
- (631) 471-9085
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 006929 | NY | Primary |
Addresses
Primary practice location
2500 Nesconset Hwy
BLDG 5D
Stonybrook, NY 11790
Mailing address
2500 Nesconset Hwy
BLDG 5D
Stonybrook, NY 11790
Phone (631) 689-7979
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00727633 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051214000366 | NY | Practitioner - Clinical Psychologist | 1850312109 | Practice locations: Stony Brook, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
2500 Nesconset Hwy
BLDG 5D
Stony Brook, NY 11790-2552
Phone (631) 689-7979
2500 Nesconset Hwy 5D
Stony Brook, NY 11790-2552
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023028362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 NESCONSET HWY",
"address_2": "BLDG 5D",
"city": "STONYBROOK",
"state": "NY",
"postal_code": "11790",
"telephone_number": "631-689-7979",
"fax_number": "631-471-9085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 NESCONSET HWY",
"address_2": "BLDG 5D",
"city": "STONYBROOK",
"state": "NY",
"postal_code": "11790",
"telephone_number": "631-689-7979",
"fax_number": "631-471-9085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAZEN",
"first_name": "MYRON",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "006929",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00727633",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stonybrook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.