NPIMap

Organization Active NPI

Supportive Care Psychiatry of Ny PC

  • Clinical Psychologist
  • Fresh Meadows, NY
National Provider Identifier
1740994433
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SUPPORTIVE CARE PSYCHIATRY OF NY PC
Practice address
7810 164TH St
Fresh Meadows, NY 11366-1229
Phone
(866) 708-1240
NPI assigned
Jan 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Authorized official

Name
Dov Newmark
Title
Ceo
Phone
(718) 298-2753

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

7810 164TH St
Fresh Meadows, NY 11366-1229

Mailing address

27 Randolph Rd
Howell, NJ 07731-8611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230214002558 NY Part B Supplier - Clinic/Group Practice 4981076247 Receives reassigned benefits from 22 practitioners
Practice locations: Bronx, NY; Fresh Meadows, NY; Syracuse, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1740994433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 RANDOLPH RD",
            "city": "HOWELL",
            "state": "NJ",
            "postal_code": "077318611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7810 164TH ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113661229",
            "telephone_number": "866-708-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE CARE PSYCHIATRY OF NY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "NEWMARK",
        "authorized_official_first_name": "DOV",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-298-2753"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresh Meadows, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.