Edward V Kornuszko Psy D PA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

EDWARD V KORNUSZKO PSY D PA

Practice address

964 Megano Blvd
Deland, FL 32724-6502

Phone

(781) 835-5664

NPI assigned

Nov 28, 2022

Last updated

Aug 21, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edward Kornuszko, PSYDNPI 1679982375

Title

President

Phone

(781) 835-5664

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

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.

• Edward Vincent Kornuszko, PSY.D.

  • Clinical Psychologist
  • Deland, FL
  • NPI 1679982375
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1225748569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "964 MEGANO BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327246502",
            "telephone_number": "781-835-5664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 MEGANO BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327246502",
            "telephone_number": "781-835-5664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD V KORNUSZKO PSY D PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-28",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A",
        "authorized_official_last_name": "KORNUSZKO",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-835-5664",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Deland, FL
• Providers in Deland, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.