Active NPI
Ali Khadivi, PH.D.
- Clinical Psychologist
- Bronx, NY
National Provider Identifier
1861523631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 011060-1
- Practice address
- 1276 Fulton Ave
4 South
Bronx, NY 10456-3402 - Phone
- (718) 901-8889
- Fax
- (718) 466-6060
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- 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 | 011060-1 | NY | Primary |
Addresses
Primary practice location
1276 Fulton Ave
4 South
Bronx, NY 10456-3402
Mailing address
210 W 101St St
PH-10
New York, NY 10025-5059
Phone (212) 662-4704
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 15, 2024 through Jun 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011060-1 | NY | MD | Physician Assistant |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861523631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 W 101ST ST",
"address_2": "PH-10",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100255059",
"telephone_number": "212-662-4704",
"fax_number": "212-662-4704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1276 FULTON AVE",
"address_2": "4 SOUTH",
"city": "BRONX",
"state": "NY",
"postal_code": "104563402",
"telephone_number": "718-901-8889",
"fax_number": "718-466-6060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHADIVI",
"first_name": "ALI",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "011060-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.