Ilyse Spertus, PH.D.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

8133543 Issued in NY

Practice address

425 Madison Avenue
Suite 1502
New York, NY 10017

Phone

(646) 942-6712

Fax

(914) 698-5571

NPI assigned

Mar 27, 2013

Last updated

Nov 9, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 1, 2020 through Feb 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1720321847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 MADISON AVENUE",
            "address_2": "SUITE 1502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10017",
            "telephone_number": "646-942-6712",
            "fax_number": "914-698-5571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 MADISON AVENUE",
            "address_2": "SUITE 1502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10017",
            "telephone_number": "646-942-6712",
            "fax_number": "914-698-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPERTUS",
        "first_name": "ILYSE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-27",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NY",
            "license": "8133543",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "8133543",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Raquel Sperling
• Marc Spero, M.D.
• Dulce Sperr
• Colin Sperring, MD
• Luisa Elizabeth Sperry, MD
• Abigail K. Spetalnik, OTR
• Marc David Spetalnik, LCSW
• Lynne Spevack, L.C.S.W.
• Jeremy Samuel Spevick, M.D.
• James Speyer, M.D.

• Cognitive & Behavioral Psychologist in New York, NY
• Providers in New York, NY by specialty
• Cognitive & Behavioral Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.