Individual provider Active NPI

Myling Sumanti, PHD

  • Clinical Psychologist
  • Brooklyn, NY
National Provider Identifier
1699873794
Registry record updated Dec 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
016600-1 Issued in NY
Practice address
5110 12TH Ave
Brooklyn, NY 11219-3424
Phone
(800) 275-3243
Fax
(937) 258-4162
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6203 OH
Clinical Psychologist 103TC0700X 016600-1 NY Primary

Addresses

Primary practice location

5110 12TH Ave
Brooklyn, NY 11219-3424

Mailing address

5110 12TH Ave
Brooklyn, NY 11219-3424
Phone (800) 275-3243

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080102000415 NY Practitioner - Clinical Psychologist 3072693100 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Che Senior Psychological Services, PCGroup PAC ID 8022905314, 227 clinicians

Practice addresses (Care Compare)

100 Franklin St
Poughkeepsie, NY 12601-4341
Phone (800) 275-3243

34 Willis Ave
Mineola, NY 11501-4406
Phone (888) 786-2684

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6203OHMDPsychologist
016600-1NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Myling Sumanti Psychology PC CurrentSince Mar 3, 2020 Accepting new patients

Locations

34 Willis Ave
Mineola, NY 11501
Phone (888) 786-2684

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197504000000",
    "number": "1699873794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5110 12TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112193424",
            "telephone_number": "800-275-3243",
            "fax_number": "937-258-4162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5110 12TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112193424",
            "telephone_number": "800-275-3243",
            "fax_number": "937-258-4162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMANTI",
        "first_name": "MYLING",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "6203",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "016600-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.