Mini Pothen

Primary specialty

PsychologistTaxonomy code 103T00000X

License

016036 Issued in NY

Practice address

7603 113TH St
Suite M6
Forest Hills, NY 11375-6530

Phone

(718) 268-1100

Fax

(718) 263-6418

NPI assigned

Sep 21, 2006

Last updated

Jul 27, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Forest Hills Psychiatric PC

  • Clinical Social Worker
  • Forest Hills, NY
  • NPI 1437218674
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185494400000",
    "number": "1548369184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16215 78TH AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113661911",
            "telephone_number": "718-591-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7603 113TH ST",
            "address_2": "SUITE M6",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113756530",
            "telephone_number": "718-268-1100",
            "fax_number": "718-263-6418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTHEN",
        "first_name": "MINI",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "016036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02797560",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Gerard Pompa, D.D.S.
• Evan Rene Poncher, MD
• Justin C Popso, D.O.
• Jaimie Lynn Porter, OTR/L CBIS
• Rayna F Portnoy, DMD
• Ziona Dasilva Powell, LMSW
• Suzette P Poyaoan, MSED
• Natalya Pozina
• Richie Pozo, MS
• Prabha Krishnan DDS P.C.

• Psychologist in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.