Individual provider Active NPI

Diana Lee Greenwald, PHD

  • Clinical Psychologist
  • New York, NY
National Provider Identifier
1366560203
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
5189 Issued in NY
Practice address
40 W 116TH St
B403
New York, NY 10026-2864
Phone
(212) 362-4856
Fax
(212) 362-4856
NPI assigned
Mar 27, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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 5189 NY Primary

Addresses

Primary practice location

40 W 116TH St
B403
New York, NY 10026-2864

Mailing address

40 W 116TH St
B403
New York, NY 10026-2864
Phone (212) 362-4856

Other identifiers 1

IdentifierTypeStateIssuer
03184970MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20091013000403 NY Practitioner - Clinical Psychologist 7517003114 Practice locations: New York, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

40 W 116TH St
Apt B403
New York, NY 10026-2866
Phone (212) 362-4856

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5189NYMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1366560203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W 116TH ST",
            "address_2": "B403",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100262864",
            "telephone_number": "212-362-4856",
            "fax_number": "212-362-4856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 W 116TH ST",
            "address_2": "B403",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100262864",
            "telephone_number": "212-362-4856",
            "fax_number": "212-362-4856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENWALD",
        "first_name": "DIANA",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "5189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03184970",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.