Active NPI
Ruth M Shaffer, PH.D.
- Clinical Psychologist
- Bronx, NY
National Provider Identifier
1386632446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 010971-1
- Practice address
- 1150 Commonwealth Ave
Bronx, NY 10472-4603 - Phone
- (718) 904-7036
- Fax
- (718) 904-7024
- NPI assigned
- Oct 12, 2005
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 010971-1 | NY | Primary |
Addresses
Primary practice location
1150 Commonwealth Ave
Bronx, NY 10472-4603
Mailing address
6746 161St St
Apt 3a
Fresh Meadows, NY 11365-3111
Phone (917) 295-6099
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01376425 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010971-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477612800000",
"number": "1386632446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6746 161ST ST",
"address_2": "APT 3A",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113653111",
"telephone_number": "917-295-6099",
"fax_number": "718-904-7006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1150 COMMONWEALTH AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104724603",
"telephone_number": "718-904-7036",
"fax_number": "718-904-7024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "RUTH",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-12",
"last_updated": "2016-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "010971-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01376425",
"state": "NY"
}
],
"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 Oct 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.