Active NPI
Evan Illouz
- Psychologist
- Brooklyn, NY
National Provider Identifier
1265989388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 021812
- Practice address
- 451 Clarkson Ave
Brooklyn, NY 11203-2054 - Phone
- (718) 245-4887
- NPI assigned
- Sep 7, 2016
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 021812 | NY | Primary |
Addresses
Primary practice location
451 Clarkson Ave
Brooklyn, NY 11203-2054
Mailing address
81 8TH Ave Apt 5
Brooklyn, NY 11215-1507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021812 | NY | MD | Physician Assistant |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1265989388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81 8TH AVE APT 5",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112151507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 CLARKSON AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032054",
"telephone_number": "718-245-4887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLOUZ",
"first_name": "EVAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-07",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "021812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; 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.