Individual provider Active NPI

Ellen L Poleshuck, PHD

  • Clinical Psychologist
  • Rochester, NY
National Provider Identifier
1356385926
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
014029 Issued in NY
Practice address
601 Elmwood Ave
Rochester, NY 14642-0002
Phone
(585) 275-2691
Fax
(585) 242-8707
NPI assigned
Jun 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 014029 NY
Psychologist 103T00000X 14029 NY
Obstetrics & Gynecology Physician 207V00000X 014029 NY
Clinical Psychologist 103TC0700X 014029 NY Primary

Addresses

Primary practice location

601 Elmwood Ave
Rochester, NY 14642-0002

Mailing address

601 Elmwood Ave
Box 668
Rochester, NY 14642-0001
Phone (585) 275-2691

Other identifiers 1

IdentifierTypeStateIssuer
0298561MedicaidNY

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address epoleshuck4924@direct.urmc.rochester.edu Direct
Direct Messaging Address epoleshuck4924@direct.urmc.rochester.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040924000730 NY Practitioner - Clinical Psychologist 1254300452 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
14029NYMDPsychologist
014029NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Strong Obstetrics-Gynecology Group Obstetrics & Gynecology CurrentSince Oct 1, 2000 Accepting new patients
University of Rochester CurrentSince Jan 1, 2021 Accepting new patients
University of Rochester CurrentSince Jan 1, 2021 Accepting new patients
Cardiac Surgery of the University of Rochester Current Accepting new patients
University of Rochester Current Accepting new patients
Acute Care Trauma of the University of Rochester Current Accepting new patients
Reproductive Endocrinology Infertility GP of Univ of Roch Current Accepting new patients

Locations

601 Elmwood Ave
#668
Rochester, NY 14642
Phone (585) 275-2691

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1356385926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "address_2": "BOX 668",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-275-2691",
            "fax_number": "585-242-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420002",
            "telephone_number": "585-275-2691",
            "fax_number": "585-242-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLESHUCK",
        "first_name": "ELLEN",
        "middle_name": "L",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2023-07-05",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "014029",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "14029",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "014029",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "014029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0298561",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "epoleshuck4924@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "epoleshuck4924@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.