Active NPI
Jerry Wishner, PH.D.
- Psychologist
- Valhalla, NY
National Provider Identifier
1093938342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 012022-1
- Practice address
- 503 Grasslands Rd
Suite 107
Valhalla, NY 10595-1503 - Phone
- (914) 763-1140
- Fax
- (914) 763-1140
- NPI assigned
- Apr 11, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 012022-1 | NY | Primary |
Addresses
Primary practice location
503 Grasslands Rd
Suite 107
Valhalla, NY 10595-1503
Mailing address
44 Gilbert St
South Salem, NY 10590-1339
Phone (914) 763-1140
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 |
|---|---|---|---|
| 012022-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428019200000",
"number": "1093938342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 GILBERT ST",
"city": "SOUTH SALEM",
"state": "NY",
"postal_code": "105901339",
"telephone_number": "914-763-1140",
"fax_number": "914-763-1140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 GRASSLANDS RD",
"address_2": "SUITE 107",
"city": "VALHALLA",
"state": "NY",
"postal_code": "105951503",
"telephone_number": "914-763-1140",
"fax_number": "914-763-1140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISHNER",
"first_name": "JERRY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2015-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "012022-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valhalla, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.