Active NPI
William Joseph Waked, PH.D.
- Clinical Neuropsychologist
- New York, NY
National Provider Identifier
1295872810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 011294-1
- Practice address
- 30 E End Ave, Suite 1C
New York, NY 10028-7053 - Phone
- (212) 795-6916
- NPI assigned
- Jan 31, 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 Neuropsychologist | 103G00000X | 011294-1 | NY | Primary |
Addresses
Primary practice location
30 E End Ave, Suite 1C
New York, NY 10028-7053
Mailing address
116 Pinehurst Ave Apt J52
New York, NY 10033-1755
Phone (121) 795-6916
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 10, 2023 through Jan 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011294-1 | NY | MD | Clinical Neuropsychologist |
| 011294 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295872810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 PINEHURST AVE APT J52",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100331755",
"telephone_number": "121-795-6916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 E END AVE, SUITE 1C",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100287053",
"telephone_number": "212-795-6916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKED",
"first_name": "WILLIAM",
"middle_name": "JOSEPH",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NY",
"license": "011294-1",
"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 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.