Active NPI
Jake Dylan Ross, PSY.D
- Clinical Child & Adolescent Psychologist
- Pleasantville, NY
National Provider Identifier
1689208027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 023603
- Practice address
- 351 Manville Rd Ste 109
Pleasantville, NY 10570-2166 - Phone
- (914) 919-9309
- NPI assigned
- Feb 25, 2020
- Sex
- Male
- 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 Child & Adolescent Psychologist | 103TC2200X | 023603 | NY | Primary |
Addresses
Primary practice location
351 Manville Rd Ste 109
Pleasantville, NY 10570-2166
Mailing address
45 Timber RDG
Mount Kisco, NY 10549-3623
Phone (516) 816-4931
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023603 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582588800000",
"number": "1689208027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 TIMBER RDG",
"city": "MOUNT KISCO",
"state": "NY",
"postal_code": "105493623",
"telephone_number": "516-816-4931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 MANVILLE RD STE 109",
"city": "PLEASANTVILLE",
"state": "NY",
"postal_code": "105702166",
"telephone_number": "914-919-9309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSS",
"first_name": "JAKE",
"middle_name": "DYLAN",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-25",
"last_updated": "2020-02-25",
"certification_date": "2020-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NY",
"license": "023603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasantville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.