Active NPI
Phyllis Kossak, PHD
- Psychologist
- Huntington, NY
National Provider Identifier
1245397918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 006747
- Practice address
- 31 Polly Drive
Huntington, NY 11743 - Phone
- (631) 423-1535
- Fax
- (631) 351-0445
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- 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 | 006747 | NY | Primary |
Addresses
Primary practice location
31 Polly Drive
Huntington, NY 11743
Mailing address
31 Polly Drive
Huntington, NY 11743
Phone (631) 423-1535
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01354094 | Medicaid | NY |
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 |
|---|---|---|---|---|
| I20041014000895 | NY | Practitioner - Clinical Psychologist | 2668432535 | Practice locations: Huntington, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
31 Polly Dr
Huntington, NY 11743-6812
Phone (631) 423-1535
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245397918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 POLLY DRIVE",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "11743",
"telephone_number": "631-423-1535",
"fax_number": "631-351-0445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 POLLY DRIVE",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "11743",
"telephone_number": "631-423-1535",
"fax_number": "631-351-0445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSSAK",
"first_name": "PHYLLIS",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "006747",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01354094",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntington, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.