Benjamin Gottesman, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021419 Issued in NY

Practice address

121 Cedar LN Ste 102
Teaneck, NJ 07666-4457

Phone

(914) 236-0832

NPI assigned

Sep 9, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Wellqor Psychological Services Northeast, PC

  • Clinical Psychologist
  • Highland Park, NJ
  • NPI 1326442567
  Medicare reassignment NPD

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1174805709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 CARLTON TER",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076663403",
            "telephone_number": "914-236-0832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 CEDAR LN STE 102",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664457",
            "telephone_number": "914-236-0832"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "503 Grasslands Rd",
            "address_2": "Suite 107",
            "address_purpose": "LOCATION",
            "city": "Valhalla",
            "state": "NY",
            "postal_code": "105951503",
            "country_code": "US",
            "telephone_number": "914-236-0832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOTTESMAN",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-09",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "021419",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Goodman, B.C.B.A.
• Sarah W Goodman, MSW, LCSW
• Devon Cordelia Gordon-Lyles, AGPNP-BC, CCRN
• Adam Gabriel Gordon, OTR/L
• Alexander J. Gordon, PH.D.
• Rachael Gottesman
• Vereen Gouldburne, NURSE PRACTITIONER
• Taylor Grader, PA-C
• Francis Joseph Graham, DMD
• Marylin Joan Granat, MSW LCSW BCD

• Clinical Psychologist in Teaneck, NJ
• Providers in Teaneck, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; 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.