Active NPI
Bennett Pologe, PH.D.
- Clinical Psychologist
- Bronx, NY
National Provider Identifier
1912069154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 10065-1
- Practice address
- 5900 Arlington Ave Apt 7a
Bronx, NY 10471-1313 - Phone
- (917) 513-7196
- Fax
- (347) 202-7166
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 10065-1 | NY | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 10065-1 | NY | |
| Forensic Psychologist | 103TF0200X | 10065-1 | NY | |
| Clinical Psychologist | 103TC0700X | 10065-1 | NY | Primary |
Addresses
Primary practice location
5900 Arlington Ave Apt 7a
Bronx, NY 10471-1313
Mailing address
5900 Arlington Ave Apt 7a
Bronx, NY 10471-1313
Phone (917) 513-7196
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10065-1 | NY | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614038400000",
"number": "1912069154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5900 ARLINGTON AVE APT 7A",
"city": "BRONX",
"state": "NY",
"postal_code": "104711313",
"telephone_number": "917-513-7196",
"fax_number": "347-202-7166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5900 ARLINGTON AVE APT 7A",
"city": "BRONX",
"state": "NY",
"postal_code": "104711313",
"telephone_number": "917-513-7196",
"fax_number": "347-202-7166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLOGE",
"first_name": "BENNETT",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2021-02-23",
"certification_date": "2021-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "10065-1",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NY",
"license": "10065-1",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "NY",
"license": "10065-1",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "10065-1",
"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 Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.