Active NPI
Baruch Elitzur, PH.D
- Clinical Psychologist
- Roslyn, NY
National Provider Identifier
1104848084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 004676-1
- Practice address
- 32 Church St
Roslyn, NY 11576-1131 - Phone
- (631) 547-9191
- NPI assigned
- Jul 23, 2006
- 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 Psychologist | 103TC0700X | 004676-1 | NY | Primary |
Addresses
Primary practice location
32 Church St
Roslyn, NY 11576-1131
Mailing address
32 Church St
Roslyn, NY 11576-1131
Phone (631) 547-9191
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 468882 | Other | NY | VALUE OPTIONS |
| EB865200 | Other | NY | GHI |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004676-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480636800000",
"number": "1104848084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 CHURCH ST",
"city": "ROSLYN",
"state": "NY",
"postal_code": "115761131",
"telephone_number": "631-547-9191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 CHURCH ST",
"city": "ROSLYN",
"state": "NY",
"postal_code": "115761131",
"telephone_number": "631-547-9191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELITZUR",
"first_name": "BARUCH",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-23",
"last_updated": "2016-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "004676-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "468882",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "EB865200",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roslyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.