Active NPI
Richard Kornblath, PHD
- Psychologist
- Boca Raton, FL
National Provider Identifier
1225046659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY0005161
- Practice address
- 400 SW 2ND Ave
#101
Boca Raton, FL 33432-5991 - Phone
- (561) 368-8512
- Fax
- (561) 394-8332
- NPI assigned
- Aug 3, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY0005161 | FL | Primary |
Addresses
Primary practice location
400 SW 2ND Ave
#101
Boca Raton, FL 33432-5991
Mailing address
400 SW Boca Raton Blvd
#101
Boca Raton, FL 33432-5991
Phone (561) 368-8512
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY0005161 | FL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342569600000",
"number": "1225046659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 SW BOCA RATON BLVD",
"address_2": "#101",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334325991",
"telephone_number": "561-368-8512",
"fax_number": "561-394-8332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 SW 2ND AVE",
"address_2": "#101",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334325991",
"telephone_number": "561-368-8512",
"fax_number": "561-394-8332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORNBLATH",
"first_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2012-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY0005161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boca Raton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.