Jay Allen Supnick, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

8678 Issued in NY

Practice address

448 White Spruce Blvd
Rochester, NY 14623-1608

Phone

(585) 424-5680

NPI assigned

Jun 11, 2006

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

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

Specialty

Clinical Psychologist

Education

State University of New York at Stony Brook, School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298505600000",
    "number": "1699717280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 WHITE SPRUCE BLVD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146231608",
            "telephone_number": "585-424-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "448 WHITE SPRUCE BLVD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146231608",
            "telephone_number": "585-424-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPNICK",
        "first_name": "JAY",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2011-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "8678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunrise Pediatrics
• Sunrise Transportation
• Sunshine Medical Services
• Anthony J Suozzi, M.D.
• Superior Home Care LLC
• Nichole S Supple, DO
• Robert Steven Supple, DDS
• Elizabeth Supra, M.D.
• Audra Elizabeth Supraski, MD
• Alana Marie Surace, NP

• Psychologist in Rochester, NY
• Providers in Rochester, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.