Michael Nettis-Benstock, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

025656 Issued in NY

Practice address

290 Birchwood Park Dr
Jericho, NY 11753-2307

Phone

(516) 376-1417

NPI assigned

Aug 19, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1699441576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 BIRCHWOOD PARK DR",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532307",
            "telephone_number": "516-376-1417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 BIRCHWOOD PARK DR",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532307",
            "telephone_number": "516-376-1417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Hudson St Fl 9",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100131810",
            "country_code": "US",
            "telephone_number": "929-260-2176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NETTIS-BENSTOCK",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "025656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert A Miller, D.O.
• Mint Dental PC
• Kathleen Molinski
• Moral Medical Care PC
• Ricky Scott Munter, D.D.S.
• Neurology and Neurosurgery of New York
• Frieda Neuschotz, M.D.
• New Hope Fertility Long Island PLLC
• New Jersey Portable X-Ray Inc
• New York Ear Nose and Throat Specialist PC

• Clinical Psychologist in Jericho, NY
• Providers in Jericho, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.