Active NPI
Alfred William Kleinbaum, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1316255342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 11541
- Practice address
- 11 Riverside Dr
Suite W4
New York, NY 10023-2504 - Phone
- (917) 734-7143
- NPI assigned
- Sep 24, 2010
- 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 | 11541 | NY | Primary |
Addresses
Primary practice location
11 Riverside Dr
Suite W4
New York, NY 10023-2504
Mailing address
653 Washington St
New York, NY 10014-2865
Phone (917) 734-7143
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 26, 2023 through Jan 26, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11541 | NY | MD | Clinical Psychologist |
| 011541 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285286400000",
"number": "1316255342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "653 WASHINGTON ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100142865",
"telephone_number": "917-734-7143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 RIVERSIDE DR",
"address_2": "SUITE W4",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100232504",
"telephone_number": "917-734-7143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLEINBAUM",
"first_name": "ALFRED",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-24",
"last_updated": "2010-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "11541",
"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 24, 2010; 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.