Kevin C Pertchik, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

015853-1 Issued in NY

Practice address

One West Avenue
Suite 205
Saratoga Springs, NY 12866

Phone

(518) 587-0499

Fax

(518) 587-0536

NPI assigned

Jul 24, 2006

Last updated

Oct 4, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286150400000",
    "number": "1780606988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE WEST AVENUE",
            "address_2": "SUITE 205",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "12866",
            "telephone_number": "518-587-0499",
            "fax_number": "518-587-0536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE WEST AVENUE",
            "address_2": "SUITE 205",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "12866",
            "telephone_number": "518-587-0499",
            "fax_number": "518-587-0536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERTCHIK",
        "first_name": "KEVIN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2010-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "015853-1",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "015853-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02525693",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Saratoga Springs, NY
• Providers in Saratoga Springs, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.