Igor Vasilj, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

692 Issued in WY

Practice address

11050 Mount Belvedere Blvd
Fort Drum, NY 13602

Phone

(315) 408-2411

NPI assigned

Aug 27, 2015

Last updated

Nov 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1225405038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-408-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "315-408-2411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11050 Mount Belvedere Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Drum",
            "state": "NY",
            "postal_code": "13602",
            "country_code": "US",
            "telephone_number": "315-408-2411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASILJ",
        "first_name": "IGOR",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-27",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WY",
            "license": "692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• US Army
• Usv Optical Inc.
• Jorge Eller Valdes, DDS
• Shannon Valencia, BCBA
• Elizabeth Vanslyke, PHARMD
• Mary Carmen Vazquez, LCSW
• Lauren Veccia-Smith, PA
• Luis Antonio Velasquez, SOCIAL WORKER
• Diondre Lamar Venable, DDS
• Sara Vescoli

• Clinical Psychologist in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.