Active NPI
Max Nisenbaum, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1336542695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 020891
- Practice address
- 75 Maiden LN
#346
New York, NY 10038-4810 - Phone
- (347) 948-4995
- NPI assigned
- Oct 1, 2014
- 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 | 020891 | NY | Primary |
Addresses
Primary practice location
75 Maiden LN
#346
New York, NY 10038-4810
Mailing address
75 Maiden LN
#220
New York, NY 10038-4810
Phone (212) 920-5816
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 |
|---|---|---|---|
| 020891 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496534400000",
"number": "1336542695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 MAIDEN LN",
"address_2": "#220",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100384810",
"telephone_number": "212-920-5816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 MAIDEN LN",
"address_2": "#346",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100384810",
"telephone_number": "347-948-4995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISENBAUM",
"first_name": "MAX",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-01",
"last_updated": "2017-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "020891",
"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 Jun 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.