Active NPI
Kimberly Fishbach
- Psychologist
- New York, NY
National Provider Identifier
1174126700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 024010
- Practice address
- 177 Prince St FL 4
New York, NY 10012-2946 - Phone
- (646) 537-1713
- NPI assigned
- Nov 17, 2020
- Sex
- Female
- 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 | 024010 | NY | Primary |
Addresses
Primary practice location
177 Prince St FL 4
New York, NY 10012-2946
Mailing address
177 Prince St FL 4
New York, NY 10012-2946
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.nyhealthhypnosis.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 20, 2020 through Nov 20, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024010 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1174126700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "177 PRINCE ST FL 4",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100122946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "177 PRINCE ST FL 4",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100122946",
"telephone_number": "646-537-1713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHBACH",
"first_name": "KIMBERLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-17",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "024010",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "www.nyhealthhypnosis.com",
"affiliation": "N",
"address_1": "177 Prince St Fl 4",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100122946",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.