Active NPI
John Peter Balistreri, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1245425826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 012264
- Practice address
- 5 E 22ND St
Suite 23-B
New York, NY 10010-5315 - Phone
- (212) 254-6081
- NPI assigned
- Sep 7, 2007
- 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 | 012264 | NY | Primary |
Addresses
Primary practice location
5 E 22ND St
Suite 23-B
New York, NY 10010-5315
Mailing address
5 E 22ND St
Suite 23-B
New York, NY 10010-5315
Phone (212) 254-6081
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 |
|---|---|---|---|---|
| I20051012000716 | NY | Practitioner - Clinical Psychologist | 3971528522 | Practice locations: New York, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5 E 22ND St
New York, NY 10010-5329
Phone (212) 254-6081
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012264 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189123200000",
"number": "1245425826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 E 22ND ST",
"address_2": "SUITE 23-B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100105315",
"telephone_number": "212-254-6081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 E 22ND ST",
"address_2": "SUITE 23-B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100105315",
"telephone_number": "212-254-6081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALISTRERI",
"first_name": "JOHN",
"middle_name": "PETER",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-07",
"last_updated": "2007-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "012264",
"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 Sep 7, 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.