Individual provider Active NPI

Timothy Stahl, PH.D.

  • Clinical Psychologist
  • New York, NY
National Provider Identifier
1659038941
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
024644 Issued in NY
Practice address
440 W 114TH St FL 6
New York, NY 10025-1796
Phone
(212) 523-6500
NPI assigned
Nov 21, 2021
Last updated
Jul 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 024644 NY Primary
Clinical Child & Adolescent Psychologist 103TC2200X 024644 NY

Addresses

Primary practice location

440 W 114TH St FL 6
New York, NY 10025-1796

Mailing address

440 W 114TH St FL 6
New York, NY 10025-1796

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tis9050@nyp.org Health Information Exchange (HIE)

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
I20220527000140 NY Practitioner - Clinical Psychologist 8224424510 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1425 Madison Ave
New York, NY 10029-6514
Phone (212) 824-8150

158 W 124TH St
New York, NY 10027-4919
Phone (212) 523-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Jun 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jun 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai PastSince Jul 31, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai PastSince Jul 31, 2022 Accepting new patients

Locations

1425 Madison Ave
New York, NY 10029
Phone (212) 824-8150

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1637452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1659038941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 W 114TH ST FL 6",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100251796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 W 114TH ST FL 6",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100251796",
            "telephone_number": "212-523-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHL",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-21",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "024644",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "024644",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tis9050@nyp.org",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3959 Broadway",
            "address_2": "CHONY 6 North",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "10032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.