Thomas P Kelly Jr., PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

P109603 Issued in NY

Practice address

575 Underhill Blvd
Syosset, NY 11791-3426

Phone

(631) 404-9844

NPI assigned

May 20, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3047/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1063087294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 CARL ST",
            "city": "LK RONKONKOMA",
            "state": "NY",
            "postal_code": "117792311",
            "telephone_number": "631-404-9844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 UNDERHILL BLVD",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117913426",
            "telephone_number": "631-404-9844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "THOMAS",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "P109603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Edward Kaufer, AU.D., CCC-SLP-A
• Jamie Michelle Kaufman, MSED
• Stephanie J. Kellen, LMT
• Ashley Kate Kelly, MS OTR/L
• Eileen Kelly, MA
• Romina Lee Keper, M.A.,CCC-SLP
• Keri Chernuchin, Psy.D. PLLC
• Dorothy Kernizan
• Danial Kessler, PH.D.
• Kgao Medical PLLC

• Psychologist in Syosset, NY
• Providers in Syosset, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; 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.