Charles Miezejeski, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6368 Issued in NY

Practice address

1745 Broadway
17 FL
New York, NY 10019-4640

Phone

(212) 851-8100

Fax

(212) 537-0102

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1235145228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "556 COLLEGE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103022510",
            "telephone_number": "718-744-5941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 BROADWAY",
            "address_2": "17 FL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100194640",
            "telephone_number": "212-851-8100",
            "fax_number": "212-537-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIEZEJESKI",
        "first_name": "CHARLES",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "6368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01676984",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Miesemer
• Ashley Alexandra Mieses, FNP
• Toni Rose Mieses, LMHC
• Sarah Miesner
• Maria Angelica Mieza, M.D
• Devika Racheal Mifflin, RN
• Evanthia Migadaki, D.M.D
• Lenore H Migdal, PHD
• Mighty Champs OT, PLLC
• Shauna Lee Mighty

• Clinical Psychologist in New York, NY
• Providers in New York, 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 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.