Renata Vaysman, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

22124 Issued in NY

Practice address

2925 W 19TH St
Brooklyn, NY 11224

Phone

(718) 616-6034

Fax

(718) 616-5694

NPI assigned

Sep 15, 2014

Reactivated

Jan 29, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Anesthesiology Associates of Boro Park, LLP

  • Pain Medicine (Anesthesiology) Physician
  • Brooklyn, NY
  • NPI 1518912302
  NPD (past)
• MMC OB-GYN Faculty Practice Plan

  • Specialist
  • Brooklyn, NY
  • NPI 1306843388
  NPD (past)

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

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1447651989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 W 19TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112242501",
            "telephone_number": "718-616-6034",
            "fax_number": "718-616-5694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 W 19TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11224",
            "telephone_number": "718-616-6034",
            "fax_number": "718-616-5694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAYSMAN",
        "first_name": "RENATA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-15",
        "last_updated": "2025-01-29",
        "deactivation_date": "2024-07-17",
        "reactivation_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "22124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAD #",
            "identifier": "02449154",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AGENCY",
            "identifier": "1285628552",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE #",
            "identifier": "WVE061",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Igor Vaysbaum, RPH
• Marina Vaysbaum, RPH
• Anna Vaysman, M.S.CCC.SLP
• Mark Vaysman, DPT
• Mirra Vaysman, MS.RPH.
• Shelly Vaysman
• Victoria Vaysman, OTR/L
• Yelena Vaysman, D.D.S.
• Yury Vaysman, CFO
• Dorean Vayspiter, CASAC-T

• Clinical Psychologist in Brooklyn, NY
• Providers in Brooklyn, 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 Jan 29, 2025; 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.