Active NPI
Mark Lawrence Dayboch, PSY.D.
- Clinical Psychologist
- Smithtown, NY
National Provider Identifier
1023136231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 009516-1
- Practice address
- 119 Fifty Acre Rd S
Smithtown, NY 11787-2034 - Phone
- (631) 979-9294
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 009516-1 | NY | Primary |
Addresses
Primary practice location
119 Fifty Acre Rd S
Smithtown, NY 11787-2034
Mailing address
119 Fifty Acre Rd S
Smithtown, NY 11787-2034
Phone (631) 979-9294
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02012224 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009516-1 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Current | Accepting new patients | |
| Alternative Psychological Services | Past | Accepting new patients | |
| Metropolitan Psychological & Licensed Master Social Work Services PLLC | Clinical | Past | Accepting new patients |
Interoperability endpoints
- markdayboch@tdh.allscriptsdirect.net
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Family Medicine Physician
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- NPI 1245403567
-
- Psychologist
- Oceanside, NY
- NPI 1093905143
-
- Clinical Psychologist
- Bay Shore, NY
- NPI 1891833588
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023136231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 FIFTY ACRE RD S",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872034",
"telephone_number": "631-979-9294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 FIFTY ACRE RD S",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872034",
"telephone_number": "631-979-9294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAYBOCH",
"first_name": "MARK",
"middle_name": "LAWRENCE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "009516-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02012224",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Smithtown, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.