Active NPI
Emanuel Kostakos, PH.D.
- School Psychologist
- Port Jefferson Station, NY
National Provider Identifier
1316157134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 010590-1
- Practice address
- 460 Old Town Rd Apt 8J
Port Jefferson Station, NY 11776-2216 - Phone
- (631) 474-0901
- NPI assigned
- May 23, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 010590-1 | NY | |
| Clinical Psychologist | 103TC0700X | 010590-1 | NY | |
| School Psychologist | 103TS0200X | 010590-1 | NY | Primary |
Addresses
Primary practice location
460 Old Town Rd Apt 8J
Port Jefferson Station, NY 11776-2216
Mailing address
460 Old Town Rd Apt 8J
Port Jefferson Station, NY 11776-2216
Phone (631) 474-0901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010590-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1316157134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 OLD TOWN RD APT 8J",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117762216",
"telephone_number": "631-474-0901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 OLD TOWN RD APT 8J",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117762216",
"telephone_number": "631-474-0901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSTAKOS",
"first_name": "EMANUEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "010590-1",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "010590-1",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NY",
"license": "010590-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.