Nissan Shliselberg, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

163429-2 Issued in NY

Practice address

12510 Queens Blvd Apt 915
Kew Gardens, NY 11415-1527

Phone

(917) 841-6034

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mental Health Providers of Western Queens, Inc.Group PAC ID 2163403148, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mental Health Providers of Western Queens, Inc.

  • Adult Mental Health Clinic/Center
  • Jackson Heights, NY
  • NPI 1477699791
  Medicare reassignment Care Compare group NPD
• Arista Center for Psychotherapy Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Forest Hills, NY
  • NPI 1346317468
  Medicare reassignment NPD
• Community Assistance Resources & Extended Services Inc

  • Case Management Agency
  • New York, NY
  • NPI 1396049987
  Medicare reassignment NPD
• Institute for the Puerto Rican Hispanic Elderly Inc.

  • Clinical Social Worker
  • Jackson Heights, NY
  • NPI 1093800211
  NPD (past)
• Samuel Field Ym&Ywha

  • Adult Mental Health Clinic/Center
  • Little Neck, NY
  • NPI 1205862950
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1720174212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12510 QUEENS BLVD APT 915",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151527",
            "telephone_number": "917-841-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12510 QUEENS BLVD APT 915",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151527",
            "telephone_number": "917-841-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHLISELBERG",
        "first_name": "NISSAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "163429-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHFIRST",
            "identifier": "163429-A37",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Shalyto
• Anzhela Shaulova, OTR/L
• Elisheva Shereshevsky Cohen, SLP
• Ruby Yang Shih, L.AC., R.PH
• Martha Shimunov
• Maryam Shoubir, DPT
• Sadia Shuja
• Si Physical Therapy
• Todd Sibener, LCSW
• Deborah Ellen Siegler

• Psychiatry Physician in Kew Gardens, NY
• Providers in Kew Gardens, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; 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.