Active NPI
Donna Kathy Nissman, PSYD
- Psychologist
- New York, NY
National Provider Identifier
1174744049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0117691
- Practice address
- 353 Lexington Ave RM 400
New York, NY 10016-1054 - Phone
- (631) 889-3307
- NPI assigned
- May 1, 2007
- 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 | 0117691 | NY | Primary |
Addresses
Primary practice location
353 Lexington Ave RM 400
New York, NY 10016-1054
Mailing address
353 Lexington Ave RM 400
New York, NY 10016-1054
Phone (631) 889-3307
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100115000585 | NY | Practitioner - Clinical Psychologist | 7113069097 | Practice locations: Northport, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1992
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
55 Sandy Hollow Rd
Northport, NY 11768-3445
Phone (631) 261-3958
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0117691 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787702400000",
"number": "1174744049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "353 LEXINGTON AVE RM 400",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100161054",
"telephone_number": "631-889-3307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "353 LEXINGTON AVE RM 400",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100161054",
"telephone_number": "631-889-3307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISSMAN",
"first_name": "DONNA",
"middle_name": "KATHY",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2026-08-26",
"certification_date": "2026-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "0117691",
"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 Aug 26, 2026; 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.