Mark Vincent Grudberg, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

018098 Issued in NY

Practice address

6083 71St St
Maspeth, NY 11378-2913

Phone

(888) 342-6002

Fax

(347) 344-6594

NPI assigned

Jul 22, 2009

Last updated

Mar 5, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Psychology of Connecticut, LLC

  • Clinical Psychologist
  • New Haven, CT
  • NPI 1679839229
  NPD Authorized official
• Pediatric Psychology of New York, PLLC

  • Clinical Psychologist
  • Maspeth, NY
  • NPI 1386910347
  NPD (past) Authorized official

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

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330905600000",
    "number": "1932339157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604434",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113604434",
            "telephone_number": "888-342-6002",
            "fax_number": "347-344-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6083 71ST ST",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113782913",
            "telephone_number": "888-342-6002",
            "fax_number": "347-344-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUDBERG",
        "first_name": "MARK",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-22",
        "last_updated": "2012-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "018098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03272364",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Spectacle Inc. Opticians
• Danielle Mercado Gregory, D.P.M.
• Rosann Gregory
• Navdeep Kaur Grewal, MD
• Dorota Gruber, M.S., GC.
• Tenzing Gyalge
• Ryan Cooper Haemmerle, PHARMD
• Bronwyn Patricia Hagan, DDS
• Fatima Hamadi
• Kathy Lynn Hamilton

• Clinical Psychologist in Maspeth, NY
• Providers in Maspeth, 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 Mar 5, 2012; 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.