Individual provider Active NPI

Jeffrey Scott Shostack, PSY.D.

  • Clinical Psychologist
  • Warminster, PA
National Provider Identifier
1366468134
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS008603L Issued in PA
Practice address
246 W Street Rd
Suite 4a
Warminster, PA 18974-3228
Phone
(215) 825-7645
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS008603L PA Primary

Addresses

Primary practice location

246 W Street Rd
Suite 4a
Warminster, PA 18974-3228

Mailing address

2215 Arch St
Apt. 401
Philadelphia, PA 19103-1328
Phone (215) 825-7645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • 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
I20050826000454 PA Practitioner - Clinical Psychologist 3476584608 Practice locations: Ardmore, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

48 Llanfair Rd
Unit 6
Ardmore, PA 19003-2413
Phone (215) 587-9067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366468134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 ARCH ST",
            "address_2": "APT. 401",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191031328",
            "telephone_number": "215-825-7645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "246 W STREET RD",
            "address_2": "SUITE 4A",
            "city": "WARMINSTER",
            "state": "PA",
            "postal_code": "189743228",
            "telephone_number": "215-825-7645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOSTACK",
        "first_name": "JEFFREY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS008603L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warminster, PA

Sources for this page

Verify at the official NPI Registry.