Active NPI
Matthew Bruce Pollack, PHD
- Clinical Psychologist
- Patchogue, NY
National Provider Identifier
1033221338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0090071
- Practice address
- 475 East Main Street
Suite 214
Patchogue, NY 11772 - Phone
- (631) 654-8507
- Fax
- (631) 654-8507
- NPI assigned
- Aug 31, 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 | 0090071 | NY | Primary |
Addresses
Primary practice location
475 East Main Street
Suite 214
Patchogue, NY 11772
Mailing address
475 East Main Street
Suite 214
Patchogue, NY 11772
Phone (631) 654-8507
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 014738859 | 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 |
|---|---|---|---|---|
| I20111220000904 | NY | Practitioner - Clinical Psychologist | 0547436602 | Practice locations: Patchogue, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
475 E Main St
Patchogue, NY 11772-3121
Phone (631) 654-8507
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009007 | NY | MD | Mental Health Counselor |
| 0090071 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321574400000",
"number": "1033221338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 EAST MAIN STREET",
"address_2": "SUITE 214",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "11772",
"telephone_number": "631-654-8507",
"fax_number": "631-654-8507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 EAST MAIN STREET",
"address_2": "SUITE 214",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "11772",
"telephone_number": "631-654-8507",
"fax_number": "631-654-8507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLACK",
"first_name": "MATTHEW",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2011-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "0090071",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "014738859",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; 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.