Active NPI
Marcia B Kimeldorf, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1588960736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 018573
- Practice address
- 506 Lenox Ave
New York, NY 10037-1802 - Phone
- (212) 939-8498
- NPI assigned
- Feb 7, 2011
- Sex
- Female
- Sole proprietor
- No
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 | 018573 | NY | Primary |
Addresses
Primary practice location
506 Lenox Ave
New York, NY 10037-1802
Mailing address
506 Lenox Ave
New York, NY 10037-1802
Phone (212) 939-8498
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018573 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521676800000",
"number": "1588960736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "506 LENOX AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100371802",
"telephone_number": "212-939-8498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "506 LENOX AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100371802",
"telephone_number": "212-939-8498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMELDORF",
"first_name": "MARCIA",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-07",
"last_updated": "2018-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "018573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.