Active NPI
Jerrold Surasky, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1235294810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7444
- Practice address
- 26 W 9TH St
#6D
New York, NY 10011-8971 - Phone
- (212) 929-1859
- Fax
- (212) 929-1859
- NPI assigned
- Dec 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 7444 | NY | Primary |
Addresses
Primary practice location
26 W 9TH St
#6D
New York, NY 10011-8971
Mailing address
26 W 9TH St
#6D
New York, NY 10011-8971
Phone (212) 929-1859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110712000254 | NY | Practitioner - Clinical Psychologist | 5698943991 | Practice locations: New York, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
26 W 9TH St
Apt 6D
New York, NY 10011-8922
Phone (212) 929-1859
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7444 | NY | MD | Clinical Psychologist |
| 007444 | NY | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487030400000",
"number": "1235294810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 W 9TH ST",
"address_2": "#6D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100118971",
"telephone_number": "212-929-1859",
"fax_number": "212-929-1859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 W 9TH ST",
"address_2": "#6D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100118971",
"telephone_number": "212-929-1859",
"fax_number": "212-929-1859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURASKY",
"first_name": "JERROLD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2017-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "7444",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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.
- 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.