Individual provider Active NPI

Jaime L Grodzicki, MD

  • Psychiatry Physician
  • Valhalla, NY
National Provider Identifier
1437100922
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
194641 Issued in NY
Practice address
95 Grasslands Road
Nymc Behavioral Health Center N326
Valhalla, NY 10595
Phone
(914) 493-7124
Fax
(914) 493-1015
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

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 194641 NY Primary

Addresses

Primary practice location

95 Grasslands Road
Nymc Behavioral Health Center N326
Valhalla, NY 10595

Mailing address

95 Grasslands Road
Nymc Behavioral Health Center N326
Valhalla, NY 10595
Phone (914) 493-7124

Other identifiers 1

IdentifierTypeStateIssuer
01685276MedicaidNY

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 Medicine

State licenses

LicenseStateTypeSpecialty
194641NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Faculty Psychological Associates PC Past Accepting new patients
Faculty Psychiatric Associates, PC Psychiatry PastSince Jul 1, 2003 Accepting new patients

Organizations & group practices 2

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207785600000",
    "number": "1437100922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 GRASSLANDS ROAD",
            "address_2": "NYMC BEHAVIORAL HEALTH CENTER N326",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "10595",
            "telephone_number": "914-493-7124",
            "fax_number": "914-493-1015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 GRASSLANDS ROAD",
            "address_2": "NYMC BEHAVIORAL HEALTH CENTER N326",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "10595",
            "telephone_number": "914-493-7124",
            "fax_number": "914-493-1015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRODZICKI",
        "first_name": "JAIME",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2008-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "194641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01685276",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valhalla, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; 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.