Active NPI
Samuel Jeannite, PSY.D
- Psychologist
- Queens, NY
National Provider Identifier
1184141053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 022015-1
- Practice address
- 118-35 Queens Blvd.
Suite 400
Queens, NY 11375 - Phone
- (347) 460-6048
- NPI assigned
- Aug 23, 2017
- Last updated
- Aug 23, 2017
- Sex
- Male
- 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 | 022015-1 | NY | Primary |
Addresses
Primary practice location
118-35 Queens Blvd.
Suite 400
Queens, NY 11375
Mailing address
17832 145TH Rd
Jamaica, NY 11434-5033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022015-1 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503446400000",
"number": "1184141053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17832 145TH RD",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114345033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118-35 QUEENS BLVD.",
"address_2": "SUITE 400",
"city": "QUEENS",
"state": "NY",
"postal_code": "11375",
"telephone_number": "347-460-6048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEANNITE",
"first_name": "SAMUEL",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-23",
"last_updated": "2017-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "022015-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queens, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.