Michael Leonard Nissenbaum, PH.D.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

010232 Issued in NY

Practice address

2100 Middle Country Rd
Suite 28W
Centereach, NY 11720-3577

Phone

(631) 737-9500

Fax

(631) 737-9512

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Clinical Psychologist

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Michael L Nissnbaum, PH.D., Psychologist, P.C.

  • Psychologist
  • Stony Brook, NY
  • NPI 1205009511
  Medicare reassignment NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• North Shore University Hospital

  • General Acute Care Hospital
  • Manhasset, NY
  • NPI 1366459570
  Care Compare affiliation

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174546725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 625",
            "city": "CENTEREACH",
            "state": "NY",
            "postal_code": "117200625",
            "telephone_number": "631-737-9500",
            "fax_number": "631-737-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 MIDDLE COUNTRY RD",
            "address_2": "SUITE 28W",
            "city": "CENTEREACH",
            "state": "NY",
            "postal_code": "117203577",
            "telephone_number": "631-737-9500",
            "fax_number": "631-737-9512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSENBAUM",
        "first_name": "MICHAEL",
        "middle_name": "LEONARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NY",
            "license": "010232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neurospine Consultants PC
• New York Dialysis Services, Inc.
• New York Physical Therapy PLLC
• New York Wellness Coach, Inc.
• Tara Newcomb
• April Louise Noon, SPECIAL EDUCATOR
• Mark A Novarro, D.C.
• On Call Homecare, Inc.
• Open-Minded Marriage & Family Therapy, PLLC
• Lisbeth Susan Ordonez, R.N.

• Cognitive & Behavioral Psychologist in Centereach, NY
• Providers in Centereach, NY by specialty
• Cognitive & Behavioral Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.