Isa L. Eliasoph, PSY.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

017411 Issued in NY

Practice address

11 Grosvenor PL
Great Neck, NY 11021-4534

Phone

(516) 482-3569

NPI assigned

Feb 20, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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

Specialty

Clinical Psychologist

Education

Albert Einstein College of Medicine of Yeshiva University, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203465600000",
    "number": "1073782322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 GROSVENOR PL",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214534",
            "telephone_number": "516-482-3569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 GROSVENOR PL",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214534",
            "telephone_number": "516-482-3569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIASOPH",
        "first_name": "ISA",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "017411",
            "primary": true
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "NY",
            "license": "017411",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NY",
            "license": "017411",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael L Eisenberg, MD, MPH
• Lara El Khoury, MD
• Elaya Health MST LLC
• Adam Abdelfatah Elba, OTR/L
• Elemental Motion Physical Therapy PLLC
• Shahryar Elihu, MD
• Eliza Haimi, DDS, PC
• Lydia Elizee, FNP
• Lloyd K Elkowitz, DDS
• Marc Jeffrey Elkowitz, MD

• Clinical Child & Adolescent Psychologist in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Clinical Child & Adolescent Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.

Verify at the official NPI Registry.