NPIMap

Organization Active NPI

Little Penguin

  • Group Psychotherapy Psychologist
  • Staten Island, NY
National Provider Identifier
1720268451
Registry record updated Nov 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
License
R065562 Issued in NY
Legal business name
LITTLE PENGUIN
Practice address
48 Blueberry Lane
Staten Island, NY 10312
Phone
(718) 967-1585
Fax
(718) 967-1585
NPI assigned
Nov 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2007

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

Authorized official

Name
Mr. Boris Mirochnik, LCSWNPI 1639254337
Title
Director Psychologist
Phone
(718) 967-1585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Group Psychotherapy PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TP2701X R065562 NY Primary

Addresses

Primary practice location

48 Blueberry Lane
Staten Island, NY 10312

Mailing address

48 Blueberry Lane
State Island, NY 10312
Phone (718) 967-1585

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194566400000",
    "number": "1720268451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 BLUEBERRY LANE",
            "city": "STATE ISLAND",
            "state": "NY",
            "postal_code": "10312",
            "telephone_number": "718-967-1585",
            "fax_number": "718-967-1585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 BLUEBERRY LANE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10312",
            "telephone_number": "718-967-1585",
            "fax_number": "718-967-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE PENGUIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-09",
        "last_updated": "2007-11-09",
        "status": "A",
        "authorized_official_last_name": "MIROCHNIK",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "DIRECTOR PSYCHOLOGIST",
        "authorized_official_telephone_number": "718-967-1585",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NY",
            "license": "R065562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.