Jeanne Ottaway, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

012589-1 Issued in NY

Practice address

279 Suffolk Ave
Staten Island, NY 10314-6948

Phone

(718) 370-9068

NPI assigned

Dec 13, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Other, 1993

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Doctor Stephanie Famulari Podiatrist PC

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  • Staten Island, NY
  • NPI 1134465321
  NPD (past)
• Welllife Network Inc.

  • Case Management Agency
  • Coram, NY
  • NPI 1386817906
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699836452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "547 PELTON AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102915",
            "telephone_number": "718-442-4391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 SUFFOLK AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146948",
            "telephone_number": "718-370-9068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTAWAY",
        "first_name": "JEANNE",
        "name_prefix": "Ms.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "012589-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "9610248",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rewieda Othman
• Hannah Gabrielle Otis, MD
• Nathan Yee Ott
• Rosemarie Ott
• Harry Ottaway, L.C.S.W.
• Lily Ottensoser
• Philip Edward Otterbeck, DDS
• Philip Edward Otterbeck, M.D.
• Victoria Angela Otterbeck, PA-C
• Carol Ann Ottesen, RN

• Psychologist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Psychologist in New York

• 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.
• 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.