Active NPI
Samuel Eli Menahem, PHD
- Clinical Psychologist
- Fort Lee, NJ
National Provider Identifier
1215032040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1261
- Practice address
- 2083 Center Ave
Suite G
Fort Lee, NJ 07024 - Phone
- (201) 944-1164
- Fax
- (201) 944-1623
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1261 | NJ | Primary |
Addresses
Primary practice location
2083 Center Ave
Suite G
Fort Lee, NJ 07024
Mailing address
2083 Center Ave
Suite G
Fort Lee, NJ 07024
Phone (201) 944-1164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110204000438 | NJ | Practitioner - Psychologist Billing Independently | 2163602350 | Practice locations: Teaneck, NJ |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
257 Grayson PL
Teaneck, NJ 07666-3435
Phone (551) 404-5950
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1261 | NJ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215032040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2083 CENTER AVE",
"address_2": "SUITE G",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "07024",
"telephone_number": "201-944-1164",
"fax_number": "201-944-1623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2083 CENTER AVE",
"address_2": "SUITE G",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "07024",
"telephone_number": "201-944-1164",
"fax_number": "201-944-1623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENAHEM",
"first_name": "SAMUEL",
"middle_name": "ELI",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "1261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lee, NJ
Sources for this page
- 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.
- 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.