Individual provider Active NPI

Roberto Estrada, M.D.

  • Geriatric Psychiatry Physician
  • New York, NY
National Provider Identifier
1063506822
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
License
232343 Issued in NY
Practice address
111 E 80TH St
Suite 1B
New York, NY 10075-0334
Phone
(212) 717-4870
Fax
(212) 717-4872
NPI assigned
Oct 3, 2006
Last updated
Sep 23, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Psychiatry Physician 2084P0805X 232343 NY Primary

Addresses

Primary practice location

111 E 80TH St
Suite 1B
New York, NY 10075-0334

Mailing address

111 E 80TH St
Suite 1B
New York, NY 10075-0334
Phone (212) 717-4870

Other identifiers 1

IdentifierTypeStateIssuer
02657867MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041029000799 NY Practitioner - Psychiatry 2567424724 Reassigns benefits to 1 organization
Practice locations: New York, NY
I20161118000155 CA Practitioner - Psychiatry 2567424724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Texas Medical School at Houston, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lenox Hill TMS Psychiatric Associates PLLCGroup PAC ID 2365767845, 2 clinicians
Bay Psychiatric AssociatesGroup PAC ID 6204723331, 60 clinicians

Practice addresses (Care Compare)

111 E 80TH St
Apt 1B
New York, NY 10075-0350
Phone (914) 593-5393

2001 Dwight Way
RM 4190
Berkeley, CA 94704-2608
Phone (510) 204-4635

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Psychiatric Associates CurrentSince Mar 2, 2020 Accepting new patients
Park Lenox Medical, PC Past Accepting new patients
Dac Physician Services,PC PastSince May 3, 2004 Accepting new patients

Locations

2001 Dwight Way
Rm 4190
Berkeley, CA 94704
Phone (510) 204-4635

2020 Milvia St
Ste 440
Berkeley, CA 94704
Phone (510) 204-4635

Organizations & group practices 4

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411430400000",
    "number": "1063506822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 80TH ST",
            "address_2": "SUITE 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100750334",
            "telephone_number": "212-717-4870",
            "fax_number": "212-717-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 80TH ST",
            "address_2": "SUITE 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100750334",
            "telephone_number": "212-717-4870",
            "fax_number": "212-717-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESTRADA",
        "first_name": "ROBERTO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NY",
            "license": "232343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02657867",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.