Active NPI
Deborah Ruben Sullum, PHD
- Psychologist
- Poughkeepsie, NY
National Provider Identifier
1770091365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 016383-1
- Practice address
- 2 Miron Dr
Poughkeepsie, NY 12603-5021 - Phone
- (845) 705-3656
- NPI assigned
- Jan 17, 2018
- Sex
- Female
- 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 | 016383-1 | NY | Primary |
Addresses
Primary practice location
2 Miron Dr
Poughkeepsie, NY 12603-5021
Mailing address
2 Miron Dr
Poughkeepsie, NY 12603-5021
Phone (845) 705-3656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016383-1 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516147200000",
"number": "1770091365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 MIRON DR",
"city": "POUGHKEEPSIE",
"state": "NY",
"postal_code": "126035021",
"telephone_number": "845-705-3656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 MIRON DR",
"city": "POUGHKEEPSIE",
"state": "NY",
"postal_code": "126035021",
"telephone_number": "845-705-3656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLUM",
"first_name": "DEBORAH",
"middle_name": "RUBEN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-17",
"last_updated": "2018-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "016383-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poughkeepsie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.