Active NPI
Tomasz Skiba, PSY.D
- Clinical Psychologist
- Long Island City, NY
National Provider Identifier
1508157116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 31010
- Practice address
- 4-75 48TH Ave.
Apt. 212
Long Island City, NY 11109-5502 - Phone
- (212) 920-7971
- NPI assigned
- Apr 29, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 31010 | CA | Primary |
Addresses
Primary practice location
4-75 48TH Ave.
Apt. 212
Long Island City, NY 11109-5502
Mailing address
4-75 48TH Ave.
Apt. 212
New York, NY 11109-5502
Phone (212) 920-7971
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31010 | Other | CA | CLINCAL LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31010 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Butterfly Effects | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566259200000",
"number": "1508157116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4-75 48TH AVE.",
"address_2": "APT. 212",
"city": "NEW YORK",
"state": "NY",
"postal_code": "111095502",
"telephone_number": "212-920-7971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4-75 48TH AVE.",
"address_2": "APT. 212",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111095502",
"telephone_number": "212-920-7971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKIBA",
"first_name": "TOMASZ",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-04-29",
"last_updated": "2019-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "31010",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLINCAL LICENSE",
"identifier": "31010",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Island City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.