Samara P Tetenbaum, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

019474 Issued in NY

Practice address

1 Expressway PLZ
Suite 106
Roslyn Heights, NY 11577-2047

Phone

(516) 621-2681

NPI assigned

Dec 4, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Samara Pulver Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Extraordinary Pediatrics, PC

  • Developmental - Behavioral Pediatrics Physician
  • New Hyde Park, NY
  • NPI 1487817250
  NPD (past)

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

{
    "created_epoch": "1354579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561939200000",
    "number": "1891030771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 HARVARD AVE",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115664429",
            "telephone_number": "516-662-5013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EXPRESSWAY PLZ",
            "address_2": "SUITE 106",
            "city": "ROSLYN HEIGHTS",
            "state": "NY",
            "postal_code": "115772047",
            "telephone_number": "516-621-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETENBAUM",
        "first_name": "SAMARA",
        "middle_name": "P",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-04",
        "last_updated": "2019-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "019474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMARA",
            "last_name": "PULVER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susanna Isaacs DDS, PC
• Leah Lavender Tabar, M.A., CCC-SLP
• Maciej Taczynski
• Jaclyn S Tane, RD
• Katie Bannon Taylor, PH.D.
• Annamma Thomas
• Matthew Tiberia, RN
• Tiny Triumphs LLC
• Walter Tozzi, RPH
• Amanda Tramutola, D.O.

• Clinical Psychologist in Roslyn Heights, NY
• Providers in Roslyn Heights, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2019; 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.