Individual provider Active NPI

Olga Magidina Nikelshpur, PH.D,

  • Clinical Neuropsychologist
  • Hackensack, NJ
National Provider Identifier
1891192852
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
35SI00622100 Issued in NJ
Practice address
360 Essex St Ste 303
Hackensack, NJ 07601-8566
Phone
(917) 769-6557
NPI assigned
Nov 19, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 020815 -1 NY
Clinical Neuropsychologist 103G00000X 35SI00622100 NJ Primary

Addresses

Primary practice location

360 Essex St Ste 303
Hackensack, NJ 07601-8566

Mailing address

360 Essex St Ste 303
Hackensack, NJ 07601-8566
Phone (917) 769-6557

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20200415003016 NJ Practitioner - Clinical Psychologist 2860822822 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

360 Essex St
Hackensack, NJ 07601-8550
Phone (201) 336-8686

Merit-based Incentive Payment System (MIPS)

Final score
81.33 of 100Reported as group
Quality
66.38
Promoting interoperability
100
Improvement activities
40
Cost
71.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
35SI00622100NJMDClinical Neuropsychologist
020815 -1NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Feb 19, 2020 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Feb 19, 2020 Accepting new patients
Hackensack Meridian Health Medical Group - Complex Care PC Past Accepting new patients

Locations

360 Essex St
Ste 303
Hackensack, NJ 07601
Phone (551) 996-3091

360 Essex St
Hackensack, NJ 07601
Phone (201) 336-8686

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

3600 State Route 66
Fl 3
Neptune City, NJ 07753
Phone (732) 807-0463

650 From Rd
Paramus, NJ 07652
Phone (201) 639-6620

Interoperability endpoints

  • Direct secure messaging: olga.nikelshpur@direct.hackensackmeridian.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1891192852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 ESSEX ST STE 303",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076018566",
            "telephone_number": "917-769-6557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 ESSEX ST STE 303",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076018566",
            "telephone_number": "917-769-6557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKELSHPUR",
        "first_name": "OLGA",
        "middle_name": "MAGIDINA",
        "credential": "PH.D,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-19",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "020815 -1",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NJ",
            "license": "35SI00622100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.