Active NPI
Justine Marie Koo, PSYD
- Psychologist
- Deer Park, NY
National Provider Identifier
1336781392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 023472
- Practice address
- 1600 Deer Park Ave
Deer Park, NY 11729-5208 - Phone
- (631) 242-2250
- NPI assigned
- Oct 11, 2019
- Sex
- Female
- 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 | 023472 | NY | Primary |
Addresses
Primary practice location
1600 Deer Park Ave
Deer Park, NY 11729-5208
Mailing address
1600 Deer Park Ave
Deer Park, NY 11729-5208
Phone (631) 242-2250
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023472 | NY | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Justine M. Koo, Psychologist P.C. | Psychologist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Bay Shore, NY
- NPI 1427741057
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570752000000",
"number": "1336781392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 DEER PARK AVE",
"city": "DEER PARK",
"state": "NY",
"postal_code": "117295208",
"telephone_number": "631-242-2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 DEER PARK AVE",
"city": "DEER PARK",
"state": "NY",
"postal_code": "117295208",
"telephone_number": "631-242-2250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOO",
"first_name": "JUSTINE",
"middle_name": "MARIE",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-11",
"last_updated": "2019-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "023472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deer Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.