Pediatric Psychology of New York, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

018098 Issued in NY

Legal business name

PEDIATRIC PSYCHOLOGY OF NEW YORK, PLLC

Practice address

6083 71St St
Maspeth, NY 11378-2913

Phone

(888) 342-6002

Fax

(347) 344-6594

NPI assigned

Mar 23, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Mark Vincent Grudberg, PH.D.NPI 1932339157

Title

Member

Phone

(888) 342-6002

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Vincent Grudberg, PH.D.

  • Clinical Psychologist
  • Maspeth, NY
  • NPI 1932339157
  NPD (past) Authorized official

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1386910347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604434",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113604434",
            "telephone_number": "888-342-6002",
            "fax_number": "347-344-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6083 71ST ST",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113782913",
            "telephone_number": "888-342-6002",
            "fax_number": "347-344-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PSYCHOLOGY OF NEW YORK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-23",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "GRUDBERG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "888-342-6002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "018098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Paek, L.AC
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• Patrycja Gerlak LCSW PC
• Kathy Peralta, RPH
• Siria C Perez, RN
• Nicole Chantal Pernod, PSY.D.
• Pharmacy on Grand Inc
• Julian Piazzola, CRNA

• Clinical Psychologist in Maspeth, NY
• Providers in Maspeth, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2012; 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.