Active NPI
Melissa Peskin
- Clinical Psychologist
- New York, NY
National Provider Identifier
1790187474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 020740
- Practice address
- 425 E 61St St
Penthouse Floor, Room 1307
New York, NY 10065-8722 - Phone
- (212) 821-0770
- Fax
- (212) 821-0994
- NPI assigned
- Sep 24, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 020740 | NY | Primary |
Addresses
Primary practice location
425 E 61St St
Penthouse Floor, Room 1307
New York, NY 10065-8722
Mailing address
525 E 68TH St
Box 200
New York, NY 10065-4870
Phone (212) 821-0770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 3, 2023 through Oct 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020740 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411516800000",
"number": "1790187474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 E 68TH ST",
"address_2": "BOX 200",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100654870",
"telephone_number": "212-821-0770",
"fax_number": "212-821-0994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 E 61ST ST",
"address_2": "PENTHOUSE FLOOR, ROOM 1307",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100658722",
"telephone_number": "212-821-0770",
"fax_number": "212-821-0994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PESKIN",
"first_name": "MELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-24",
"last_updated": "2014-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "020740",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.