Individual provider Active NPI

Donald A Skinner, PH.D.

  • Clinical Psychologist
  • Ridgewood, NJ
National Provider Identifier
1457438210
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35SI00222500 Issued in NJ
Practice address
172 Franklin Ave
Suite 4B
Ridgewood, NJ 07450-3250
Phone
(201) 670-7490
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 35SI00222500 NJ Primary

Addresses

Primary practice location

172 Franklin Ave
Suite 4B
Ridgewood, NJ 07450-3250

Mailing address

172 Franklin Ave
Suite 4B
Ridgewood, NJ 07450-3250
Phone (201) 670-7490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050602000609 NJ Practitioner - Clinical Psychologist 8729021605 Practice locations: Ridgewood, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

172 Franklin Ave
Suite 4B
Ridgewood, NJ 07450-3229
Phone (201) 670-7490

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457438210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 FRANKLIN AVE",
            "address_2": "SUITE 4B",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503250",
            "telephone_number": "201-670-7490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 FRANKLIN AVE",
            "address_2": "SUITE 4B",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503250",
            "telephone_number": "201-670-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKINNER",
        "first_name": "DONALD",
        "middle_name": "A",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00222500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NJ

Sources for this page

Verify at the official NPI Registry.