Individual provider Active NPI

Keziah Kallarakal, PSYD

  • Psychologist
  • Astoria, NY
National Provider Identifier
1629393194
Registry record updated Mar 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
68 017125 Issued in NY
Practice address
3811 Broadway FL 3
Astoria, NY 11103-4045
Phone
(718) 726-5953
Fax
(718) 204-5308
NPI assigned
Mar 29, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 68 017125 NY Primary

Addresses

Primary practice location

3811 Broadway FL 3
Astoria, NY 11103-4045

Mailing address

3811 Broadway FL 3
Astoria, NY 11103-4045
Phone (718) 726-5953

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20100901000260 NY Practitioner - Clinical Psychologist 5799809422 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
68 017125NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Knapp Street Psychiatry, PC CurrentSince Jul 4, 2010 Accepting new patients
Che Senior Psychological Services, PC CurrentSince Jul 4, 2010 Accepting new patients
Steinway Wellness and Recovery Past Accepting new patients

Locations

3512 Quentin Rd
Ste 110
Brooklyn, NY 11234
Phone (718) 854-8370

1915 Ocean Ave
Brooklyn, NY 11230
Phone (718) 258-7700

250 Beach 17th St
Far Rockaway, NY 11691
Phone (516) 670-0212

209 Beach 125th St
Rockaway Park, NY 11694
Phone (516) 721-7625

135 Vanderbilt Ave
Staten Island, NY 10304
Phone (718) 447-0101

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269820800000",
    "number": "1629393194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 BROADWAY FL 3",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111034045",
            "telephone_number": "718-726-5953",
            "fax_number": "718-204-5308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 BROADWAY FL 3",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111034045",
            "telephone_number": "718-726-5953",
            "fax_number": "718-204-5308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLARAKAL",
        "first_name": "KEZIAH",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-29",
        "last_updated": "2010-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "68 017125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

Verify at the official NPI Registry.