Active NPI
Mark Lyall, PSY.D
- Psychologist
- Nutley, NJ
National Provider Identifier
1730595349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 35SL00514400
- Practice address
- 610 Franklin Ave
Nutley, NJ 07110-1244 - Phone
- (973) 798-2536
- NPI assigned
- Jul 2, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 35SL00514400 | NJ | Primary |
Addresses
Primary practice location
610 Franklin Ave
Nutley, NJ 07110-1244
Mailing address
610 Franklin Avenue
Nutley, NJ 07110
Phone (973) 798-2536
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 25, 2021 through Jul 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SL00514400 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407974400000",
"number": "1730595349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 FRANKLIN AVENUE",
"city": "NUTLEY",
"state": "NJ",
"postal_code": "07110",
"telephone_number": "973-798-2536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 FRANKLIN AVE",
"city": "NUTLEY",
"state": "NJ",
"postal_code": "071101244",
"telephone_number": "973-798-2536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYALL",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-02",
"last_updated": "2014-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "35SL00514400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nutley, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; 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.