Nassau-Suffolk Psychology PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

018160 Issued in NY

Legal business name

NASSAU-SUFFOLK PSYCHOLOGY PC

Practice address

1563 Montauk Hwy
Oakdale, NY 11769-1322

Phone

(631) 563-3162

Fax

(631) 563-3185

NPI assigned

Feb 17, 2011

Organization subpart

No

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

Authorized official

Name

Dr. David Pace, PSY.D.NPI 1649413535

Title

President

Phone

(631) 563-3162

Specialties & licenses 1

Addresses

Other names 1

• Dr. David Pace Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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

• David Pace, PSY.D.

  • Psychologist
  • Oakdale, NY
  • NPI 1649413535
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1297900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297900800000",
    "number": "1730486226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1563 MONTAUK HWY",
            "city": "OAKDALE",
            "state": "NY",
            "postal_code": "117691322",
            "telephone_number": "631-563-3162",
            "fax_number": "631-563-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1563 MONTAUK HWY",
            "city": "OAKDALE",
            "state": "NY",
            "postal_code": "117691322",
            "telephone_number": "631-563-3162",
            "fax_number": "631-563-3185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NASSAU-SUFFOLK PSYCHOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-17",
        "last_updated": "2011-02-17",
        "status": "A",
        "authorized_official_last_name": "PACE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-563-3162",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "018160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. David Pace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Psychologist in Oakdale, NY
• Providers in Oakdale, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.