Active NPI
Dominick Edwin Grundy, PH.D.
- Psychologist
- New York, NY
National Provider Identifier
1619099462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 010741-1
- Practice address
- 545 W End Ave
Apartment 11D
New York, NY 10024-2713 - Phone
- (212) 874-6929
- NPI assigned
- Apr 4, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 010741-1 | NY | Primary |
Addresses
Primary practice location
545 W End Ave
Apartment 11D
New York, NY 10024-2713
Mailing address
545 W End Ave
Apartment 11D
New York, NY 10024-2713
Phone (212) 874-6929
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010741-1 | Other | NY | PSYCHOLOGY 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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010741-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619099462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 W END AVE",
"address_2": "APARTMENT 11D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100242713",
"telephone_number": "212-874-6929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 W END AVE",
"address_2": "APARTMENT 11D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100242713",
"telephone_number": "212-874-6929"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUNDY",
"first_name": "DOMINICK",
"middle_name": "EDWIN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "010741-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "010741-1",
"state": "NY"
}
],
"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 Jul 8, 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.