Active NPI
Greg Kidorf, PH.D.
- Clinical Child & Adolescent Psychologist
- Willow Grove, PA
National Provider Identifier
1093589905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 008606-L
- Practice address
- 630 Fitzwatertown Rd
Willow Grove, PA 19090-1927 - Phone
- (267) 861-3635
- NPI assigned
- Nov 10, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 008606-L | PA | Primary |
Addresses
Primary practice location
630 Fitzwatertown Rd
Willow Grove, PA 19090-1927
Mailing address
1537 Lexington Dr
Dresher, PA 19025-1255
Phone (215) 641-0808
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008606-L | PA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699574400000",
"number": "1093589905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1537 LEXINGTON DR",
"city": "DRESHER",
"state": "PA",
"postal_code": "190251255",
"telephone_number": "215-641-0808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 FITZWATERTOWN RD",
"city": "WILLOW GROVE",
"state": "PA",
"postal_code": "190901927",
"telephone_number": "267-861-3635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDORF",
"first_name": "GREG",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-10",
"last_updated": "2023-11-10",
"certification_date": "2023-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "PA",
"license": "008606-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willow Grove, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.