Individual provider Active NPI

Eva Fogelman, PH.D

  • Psychologist
  • New York, NY
National Provider Identifier
1508077769
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
012449 Issued in NY
Practice address
211 W 56TH St
Suite 7K
New York, NY 10019-4312
Phone
(212) 315-5872
NPI assigned
May 26, 2007
Sex
Female
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
Psychologist 103T00000X 012449 NY Primary

Addresses

Primary practice location

211 W 56TH St
Suite 7K
New York, NY 10019-4312

Mailing address

211 W 56TH St
Suite 7K
New York, NY 10019-4312
Phone (212) 315-5872

Other identifiers 2

IdentifierTypeStateIssuer
4422587OtherNYOXFORD
01671594MedicaidNY

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050727000308 NY Practitioner - Clinical Psychologist 7113955659 Practice locations: New York, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

211 W 56TH St
Apt 7K
New York, NY 10019-4317

60 Riverside Dr
Apt 7C
New York, NY 10024-6137
Phone (917) 363-6249

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": "1180137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508077769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W 56TH ST",
            "address_2": "SUITE 7K",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100194312",
            "telephone_number": "212-315-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W 56TH ST",
            "address_2": "SUITE 7K",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100194312",
            "telephone_number": "212-315-5872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGELMAN",
        "first_name": "EVA",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "012449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "4422587",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01671594",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.