NPIMap

Organization Active NPI

Jerry Duvinsky PHD Licensed Psychologist PC

  • Clinical Psychologist
  • Endicott, NY
National Provider Identifier
1043684681
Registry record updated Nov 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
010363 Issued in NY
Legal business name
JERRY DUVINSKY PHD LICENSED PSYCHOLOGIST PC
Practice address
423 E Main St Ste 3
Endicott, NY 13760-6940
Phone
(607) 754-1101
Fax
(607) 754-1107
NPI assigned
Nov 19, 2015
Last updated
Nov 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2015

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

Authorized official

Name
Dr. Jerry Duvinsky, PH.D.NPI 1265504211
Title
President
Phone
(607) 754-1101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 010363 NY Primary

Addresses

Primary practice location

423 E Main St Ste 3
Endicott, NY 13760-6940

Mailing address

423 E Main St Ste 3
Endicott, NY 13760-6940
Phone (607) 754-1101

Other identifiers 1

IdentifierTypeStateIssuer
01409512MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160104000151 NY Part B Supplier - Clinic/Group Practice 4587965223 Receives reassigned benefits from 1 practitioner
Practice locations: Vestal, NY

National Provider Directory

National Provider Directory

Locations

423 E Main St
Ste 3
Endicott, NY 13760
Phone (607) 754-1101

116A Clayton Ave
Vestal, NY 13850
Phone (607) 754-1101

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1447891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1043684681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 E MAIN ST STE 3",
            "city": "ENDICOTT",
            "state": "NY",
            "postal_code": "137606940",
            "telephone_number": "607-754-1101",
            "fax_number": "607-754-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 E MAIN ST STE 3",
            "city": "ENDICOTT",
            "state": "NY",
            "postal_code": "137606940",
            "telephone_number": "607-754-1101",
            "fax_number": "607-754-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY DUVINSKY PHD LICENSED PSYCHOLOGIST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-19",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "DUVINSKY",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "607-754-1101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "010363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01409512",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Endicott, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.