Individual provider Active NPI

Concepcion Jusino Jr., PSY.D.

  • Psychologist
  • New York, NY
National Provider Identifier
1881736262
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
012665-1 Issued in NY
Practice address
407 E 81St St Apt 1a
New York, NY 10028-5831
Phone
(201) 892-3594
NPI assigned
Feb 13, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 012665-1 NY Primary

Addresses

Primary practice location

407 E 81St St Apt 1a
New York, NY 10028-5831

Mailing address

107 Christopher Columbus Dr Apt 1B
Jersey City, NJ 07302-3500
Phone (201) 892-3594

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181106002001 NY Practitioner - Clinical Psychologist 0547514739 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York City Health and Hospitals CorporationGroup PAC ID 4183535305, 543 clinicians

Practice addresses (Care Compare)

1901 1St Ave
RM 5M44
New York, NY 10029-7494
Phone (212) 423-6262

Hospital & facility affiliations

  • Metropolitan Hospital Center Hospital, New York, NY, CCN 330199

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
012665-1NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Nysarc Inc CurrentSince Oct 5, 2018 Accepting new patients

Locations

83 Maiden Ln
Fl 7
New York, NY 10038
Phone (212) 780-2564

83 Maiden Ln
Fl 5
New York, NY 10038
Phone (212) 780-2564

83 Maiden Ln
New York, NY 10038
Phone (212) 780-2578

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1881736262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 CHRISTOPHER COLUMBUS DR APT 1B",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073023500",
            "telephone_number": "201-892-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E 81ST ST APT 1A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100285831",
            "telephone_number": "201-892-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUSINO",
        "first_name": "CONCEPCION",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "012665-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.