Active NPI
Ahmed Enaitalla, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1134844509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 024961
- Practice address
- 235 E 20TH St
New York, NY 10003-1801 - Phone
- (718) 312-5353
- NPI assigned
- Oct 7, 2022
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | |||
| Forensic Psychologist | 103TF0200X | |||
| Clinical Psychologist | 103TC0700X | 024961 | NY | Primary |
Addresses
Primary practice location
235 E 20TH St
New York, NY 10003-1801
Mailing address
235 E 20TH St FL 7
New York, NY 10003-1801
Phone (347) 674-8683
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 |
|---|---|---|---|
| 024961 | NY | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pasadena Clinical Group, a Psychology Corporation | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665705600000",
"number": "1134844509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "235 E 20TH ST FL 7",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100031801",
"telephone_number": "347-674-8683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 E 20TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100031801",
"telephone_number": "718-312-5353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENAITALLA",
"first_name": "AHMED",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-07",
"last_updated": "2022-10-14",
"certification_date": "2022-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "024961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.