Active NPI
Phyllis W Palm, PHD
- Psychologist
- New York, NY
National Provider Identifier
1790949675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2960
- Practice address
- 125 Riverside Dr
Suite 1E
New York, NY 10024-3710 - Phone
- (646) 265-8570
- NPI assigned
- Jul 10, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 7825 | NY | |
| Psychologist | 103T00000X | 2960 | NJ | Primary |
Addresses
Primary practice location
125 Riverside Dr
Suite 1E
New York, NY 10024-3710
Mailing address
125 Riverside Dr
Suite 1E
New York, NY 10024-3710
Phone (646) 265-8570
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2960 | NJ | MD | Psychologist |
| 7825 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215648000000",
"number": "1790949675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 RIVERSIDE DR",
"address_2": "SUITE 1E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100243710",
"telephone_number": "646-265-8570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 RIVERSIDE DR",
"address_2": "SUITE 1E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100243710",
"telephone_number": "646-265-8570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALM",
"first_name": "PHYLLIS",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-10",
"last_updated": "2008-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "7825",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "2960",
"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 Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.