George Jory Wixsom, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

224685-1 Issued in NY

Practice address

20 W Park Ave
Suite 310B
Long Beach, NY 11561-2033

Phone

(516) 978-1612

Fax

(516) 374-2261

NPI assigned

Nov 29, 2006

Last updated

Jun 28, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Department of State Hospitals

  dba Coalinga State Hospital

  • Psychiatric Hospital
  • Coalinga, CA
  • NPI 1124078704
  NPD
• Department of State Hospitals

  dba Department of State Hospitals-Atascadero

  • Psychiatric Hospital
  • Atascadero, CA
  • NPI 1174573802
  NPD
• Department of State Hospitals

  dba Department of State Hospitals - Metropolitan

  • Psychiatric Hospital
  • Norwalk, CA
  • NPI 1265406565
  NPD
• Barbara a. Romano, PH.D., Psychologist, P.C.

  • Clinical Psychologist
  • Huntington, NY
  • NPI 1588992002
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372377600000",
    "number": "1114094612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 W. HAWTHORNE AVE.",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "11598",
            "telephone_number": "516-569-6600",
            "fax_number": "516-374-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 W PARK AVE",
            "address_2": "SUITE 310B",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115612033",
            "telephone_number": "516-978-1612",
            "fax_number": "516-374-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIXSOM",
        "first_name": "GEORGE",
        "middle_name": "JORY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2013-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "224685-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02406628",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Winn
• Winthrop Community Medical Affiliates, P.C. (Beach Internal Medicine)
• Lisa Marie Wisel, MS,ADTR-LCAT
• Darryl Wayne Zacharia Wisher, R.PH
• Amanda Greer Wisniewski, MA, CCC-SLP, TSSLD
• David Ming-Hai Wu, DDS
• Ioanna Xanthakys, RPH
• Pinkhus Yakubov, OTR/L
• Cindy Yap, FNP
• Dana Youkilis, RD

• Child & Adolescent Psychiatry Physician in Long Beach, NY
• Providers in Long Beach, NY by specialty
• Child & Adolescent Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.