Jeffry Luria, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

004773 Issued in NY

Practice address

847 Grovenors Corners Rd
Central Bridge, NY 12035-2003

Phone

(518) 296-8524

Fax

(518) 296-8536

NPI assigned

Jul 4, 2006

Last updated

Jul 20, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

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

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216512000000",
    "number": "1528098621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 GROVENORS CORNERS RD",
            "city": "CENTRAL BRIDGE",
            "state": "NY",
            "postal_code": "120352003",
            "telephone_number": "518-296-8524",
            "fax_number": "518-296-8536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "847 GROVENORS CORNERS RD",
            "city": "CENTRAL BRIDGE",
            "state": "NY",
            "postal_code": "120352003",
            "telephone_number": "518-296-8524",
            "fax_number": "518-296-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LURIA",
        "first_name": "JEFFRY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2008-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "004773",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "004773",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "NY",
            "license": "004773",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKER'S COMPENSATION",
            "identifier": "S-04773-8B",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Central Bridge Fire District
• Nicholas Edward Snyder
• Amanda Lynn Waszkiewicz, CERTIFIED COACH

• Clinical Psychologist in Central Bridge, NY
• Providers in Central Bridge, 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 Jul 20, 2008; 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.