NPIMap

Organization Active NPI

Supportive Care of Pennsylvania LLC

  • Clinical Psychologist
  • Monsey, NY
National Provider Identifier
1174992275
Registry record updated Sep 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SUPPORTIVE CARE OF PENNSYLVANIA LLC
Practice address
20 Robert Pitt Dr
Unit 209
Monsey, NY 10952-3330
Phone
(845) 826-0060
NPI assigned
Sep 18, 2015
Last updated
Sep 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2015

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

Authorized official

Name
Joel Meisels
Title
President
Phone
(845) 826-0060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

20 Robert Pitt Dr
Unit 209
Monsey, NY 10952-3330

Mailing address

20 Robert Pitt Dr
Unit 209
Monsey, NY 10952-3330
Phone (845) 826-0060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151214002225 PA Part B Supplier - Clinic/Group Practice 0143521211 Receives reassigned benefits from 157 practitioners
Practice locations: Philadelphia, PA; York, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 169

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 169

NPI Registry JSON

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442534400000",
    "number": "1174992275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 ROBERT PITT DR",
            "address_2": "UNIT 209",
            "city": "MONSEY",
            "state": "NY",
            "postal_code": "109523330",
            "telephone_number": "845-826-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 ROBERT PITT DR",
            "address_2": "UNIT 209",
            "city": "MONSEY",
            "state": "NY",
            "postal_code": "109523330",
            "telephone_number": "845-826-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE CARE OF PENNSYLVANIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2015-09-18",
        "status": "A",
        "authorized_official_last_name": "MEISELS",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "845-826-0060"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monsey, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.