Henry S Roane

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

018405 Issued in NY

Practice address

600 East Genesee St
Suite 130
Syracuse, NY 13202

Phone

(315) 464-3103

Fax

(315) 464-3944

NPI assigned

Mar 23, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Pediatric Service Group

  • Pediatrics Physician
  • Syracuse, NY
  • NPI 1770539066
  Medicare reassignment NPD

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1467579730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 SALINA MEADOWS PKWY",
            "address_2": "SUITE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132124516",
            "telephone_number": "315-464-2000",
            "fax_number": "315-464-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 EAST GENESEE ST",
            "address_2": "SUITE 130",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13202",
            "telephone_number": "315-464-3103",
            "fax_number": "315-464-3944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROANE",
        "first_name": "HENRY",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NY",
            "license": "018405",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NE",
            "license": "667",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025287200",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• RK-Allure LLC
• Kristina Roach, M.S.
• Lindsay Roach
• Stephanie Ann-Phillips Roach
• Taylor Roadarmel
• Carliza Ellen Roark
• Erick Stephenson Roat, PHD
• Janine M Robbins, NP
• Makenzie Mary Robbins, PT, DPT
• Reinele F. Robbins, PA-C

• Cognitive & Behavioral Psychologist in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Cognitive & Behavioral Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.