Individual provider Active NPI

Candice Isabel Hacker, M.D.

  • Psychiatry Physician
  • New York, NY
National Provider Identifier
1407092919
Registry record updated Jan 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
249747-1 Issued in NY
Practice address
1090 Amsterdam Ave
New York, NY 10025-1737
Phone
(212) 523-7713
NPI assigned
Jan 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 249747-1 NY Primary

Addresses

Primary practice location

1090 Amsterdam Ave
New York, NY 10025-1737

Mailing address

790 Riverside Dr
Apt. 3D
New York, NY 10032-7459
Phone (212) 234-0210

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090521000193 NY Practitioner - Psychiatry 2163571118 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Temple University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCCD Psychiatry Services PLLCGroup PAC ID 4082049036, 206 clinicians

Practice addresses (Care Compare)

109 W 27TH St
5S
New York, NY 10001-6208
Phone (833) 351-8255

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
249747-1NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD Psychiatry Services PLLC Psychiatry CurrentSince Nov 4, 2024 Accepting new patients

Locations

109 W 27th St
#55
New York, NY 10001

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231113600000",
    "number": "1407092919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 RIVERSIDE DR",
            "address_2": "APT. 3D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100327459",
            "telephone_number": "212-234-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 AMSTERDAM AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100251737",
            "telephone_number": "212-523-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKER",
        "first_name": "CANDICE",
        "middle_name": "ISABEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-05",
        "last_updated": "2009-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "249747-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.