Active NPI
Gregory Asa Max, M.D.
- Psychiatry Physician
- Oswego, NY
National Provider Identifier
1538138615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 156672-1
- Practice address
- 74 Bunner Street
Oswego, NY 13126 - Phone
- (718) 960-6159
- NPI assigned
- Mar 14, 2006
- Last updated
- Apr 10, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Neuromusculoskeletal Medicine) Physician | 204C00000X | 156672-1 | NY | |
| Psychiatry Physician | 2084P0800X | 156672-1 | NY | Primary |
Addresses
Primary practice location
74 Bunner Street
Oswego, NY 13126
Mailing address
110 West 6TH Street
Oswego, NY 13126
Phone (718) 960-6159
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01822595 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 156672-1 | NY | MD | Sports Medicine (Neuromusculoskeletal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428624000000",
"number": "1538138615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 WEST 6TH STREET",
"city": "OSWEGO",
"state": "NY",
"postal_code": "13126",
"telephone_number": "718-960-6159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 BUNNER STREET",
"city": "OSWEGO",
"state": "NY",
"postal_code": "13126",
"telephone_number": "718-960-6159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAX",
"first_name": "GREGORY",
"middle_name": "ASA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2015-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "204C00000X",
"taxonomy_group": "",
"desc": "Neuromusculoskeletal Medicine, Sports Medicine",
"state": "NY",
"license": "156672-1",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "156672-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01822595",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oswego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.