Individual provider Active NPI

Susan J. Vig, PH.D.

  • Psychologist
  • Bronx, NY
National Provider Identifier
1366655565
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
7874 Issued in NY
Practice address
1410 Pelham Pkwy S
Kennedy Center Cerc
Bronx, NY 10461-1116
Phone
(718) 430-8514
Fax
(718) 892-2296
NPI assigned
May 7, 2007
Sex
Female
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
Psychologist 103T00000X 7874 NY Primary

Addresses

Primary practice location

1410 Pelham Pkwy S
Kennedy Center Cerc
Bronx, NY 10461-1116

Mailing address

1410 Pelham Pkwy S
Kennedy Center Cerc
Bronx, NY 10461-1116
Phone (718) 430-8514

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

LicenseStateTypeSpecialty
7874NYMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366655565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 PELHAM PKWY S",
            "address_2": "KENNEDY CENTER CERC",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611116",
            "telephone_number": "718-430-8514",
            "fax_number": "718-892-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 PELHAM PKWY S",
            "address_2": "KENNEDY CENTER CERC",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611116",
            "telephone_number": "718-430-8514",
            "fax_number": "718-892-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIG",
        "first_name": "SUSAN",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "7874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.