Individual provider Active NPI

Steven Fedchak, PSY.D.

  • Clinical Child & Adolescent Psychologist
  • Rochester, NY
National Provider Identifier
1063290716
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Practice address
200 E River Rd
Rochester, NY 14623-1212
Phone
(716) 541-4743
NPI assigned
Sep 14, 2023
Last updated
Sep 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X NY Primary

Addresses

Primary practice location

200 E River Rd
Rochester, NY 14623-1212

Mailing address

601 Elmwood Ave Box 671
Rochester, NY 14642-0001

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231023002611 NY Practitioner - Clinical Psychologist 0042666349 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Development Clinic CurrentSince Nov 27, 2023 Accepting new patients

Locations

200 E River Rd
Rochester, NY 14623
Phone (585) 275-2808

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

601 Elmwood Ave
#635
Rochester, NY 14642
Phone (585) 275-2821

601 Elmwood Ave
#671
Rochester, NY 14642
Phone (585) 275-2986

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1694649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1063290716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE BOX 671",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E RIVER RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146231212",
            "telephone_number": "716-541-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDCHAK",
        "first_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-14",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.