Active NPI
Jonathan Fader, PHD
- Clinical Psychologist
- New York, NY
National Provider Identifier
1710971064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 016156
- Practice address
- 138 W 25TH St FL 10
New York, NY 10001-7470 - Phone
- (212) 335-2100
- Fax
- (646) 775-4142
- NPI assigned
- Sep 1, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 016156 | NY | Primary |
Addresses
Primary practice location
138 W 25TH St FL 10
New York, NY 10001-7470
Mailing address
138 W 25TH St FL 10
New York, NY 10001-7470
Phone (212) 335-2100
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 May 22, 2018 through May 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016156 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613260800000",
"number": "1710971064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 W 25TH ST FL 10",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100017470",
"telephone_number": "212-335-2100",
"fax_number": "646-775-4142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 W 25TH ST FL 10",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100017470",
"telephone_number": "212-335-2100",
"fax_number": "646-775-4142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FADER",
"first_name": "JONATHAN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-01",
"last_updated": "2021-02-14",
"certification_date": "2021-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "016156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
- Faculty Practice Associates Mount Sinai School of Medicine
- Faculty Practice Associates Mt Sinai School of Medicine
- Faculty Practice Associatge, Mount Sinai School of Medicine
- Kristen Fadel, MD
- Deborah Fader, LCSW
- Ralph Parker Fader IV, M.D.
- Sharon Rebecca Fader, LCSW
- Thelma Villar Faderan
- Fadeyi Dermatology PLLC
- Darice Williams Fadeyi, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2021; 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.