Active NPI
David S. Macisaac, PH.D.
- Psychoanalysis Psychologist
- Englewood, NJ
National Provider Identifier
1689770307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychoanalysis Psychologist
- License
- 35S100128700
- Practice address
- 163 Engle St Ste 1a
Englewood, NJ 07631-2530 - Phone
- (201) 569-0566
- NPI assigned
- Sep 16, 2006
- 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 |
|---|---|---|---|---|
| Psychoanalysis Psychologist | 103TP0814X | 35S100128700 | NJ | Primary |
Addresses
Primary practice location
163 Engle St Ste 1a
Englewood, NJ 07631-2530
Mailing address
163 Engle St Ste 1a
Englewood, NJ 07631-2530
Phone (201) 569-0566
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 20, 2006 through Apr 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35S100128700 | NJ | MD | Psychoanalysis Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689770307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 ENGLE ST STE 1A",
"city": "ENGLEWOOD",
"state": "NJ",
"postal_code": "076312530",
"telephone_number": "201-569-0566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 ENGLE ST STE 1A",
"city": "ENGLEWOOD",
"state": "NJ",
"postal_code": "076312530",
"telephone_number": "201-569-0566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACISAAC",
"first_name": "DAVID",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TP0814X",
"taxonomy_group": "",
"desc": "Psychologist, Psychoanalysis",
"state": "NJ",
"license": "35S100128700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Englewood, NJ
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.