Active NPI
Anthony John Pavlo, PHD
- Clinical Psychologist
- Sunnyside, NY
National Provider Identifier
1689377293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 025509
- Practice address
- 4331 45TH St Apt 3J
Sunnyside, NY 11104-2347 - Phone
- (347) 871-1104
- NPI assigned
- Mar 23, 2023
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 025509 | NY | Primary |
Addresses
Primary practice location
4331 45TH St Apt 3J
Sunnyside, NY 11104-2347
Mailing address
4331 45TH St Apt 3J
Sunnyside, NY 11104-2347
Phone (347) 871-1104
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 |
|---|---|---|---|
| 025509 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679529600000",
"number": "1689377293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4331 45TH ST APT 3J",
"city": "SUNNYSIDE",
"state": "NY",
"postal_code": "111042347",
"telephone_number": "347-871-1104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4331 45TH ST APT 3J",
"city": "SUNNYSIDE",
"state": "NY",
"postal_code": "111042347",
"telephone_number": "347-871-1104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAVLO",
"first_name": "ANTHONY",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-23",
"last_updated": "2023-03-23",
"certification_date": "2023-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "025509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sunnyside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.