Individual provider Active NPI

Susan A. Grossbard, PSY.D.

  • Psychologist
  • Wayne, NJ
National Provider Identifier
1164631313
Registry record updated Feb 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
35S100385300 Issued in NJ
Practice address
600 Valley Rd
Suite 205
Wayne, NJ 07470-3535
Phone
(973) 715-9446
NPI assigned
May 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2010

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 35S100385300 NJ Primary
Cognitive & Behavioral Psychologist 103TB0200X 35SI00385300 NJ
Clinical Child & Adolescent Psychologist 103TC2200X 35SI00385300 NJ
Intellectual & Developmental Disabilities Psychologist 103TM1800X 35SI00385300 NJ
School Psychologist 103TS0200X 35SI00385300 NJ

Addresses

Primary practice location

600 Valley Rd
Suite 205
Wayne, NJ 07470-3535

Mailing address

70 Hershey Rd
Wayne, NJ 07470-5536
Phone (973) 715-9446

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101130000344 NJ Practitioner - Clinical Psychologist 5193911329 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35S100385300NJMDPsychologist
35SI00385300NJMDCognitive & Behavioral Psychologist

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265068800000",
    "number": "1164631313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 HERSHEY RD",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074705536",
            "telephone_number": "973-715-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 VALLEY RD",
            "address_2": "SUITE 205",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074703535",
            "telephone_number": "973-715-9446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSSBARD",
        "first_name": "SUSAN",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2010-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "35S100385300",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NJ",
            "license": "35SI00385300",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NJ",
            "license": "35SI00385300",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NJ",
            "license": "35SI00385300",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NJ",
            "license": "35SI00385300",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

Verify at the official NPI Registry.