Active NPI
Michelle Ilene Lupkin, PH.D.
- Clinical Psychologist
- Teaneck, NJ
National Provider Identifier
1972854016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 019630-1
- Practice address
- 513 Ogden Ave
Teaneck, NJ 07666-2935 - Phone
- (917) 570-7472
- NPI assigned
- Sep 28, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 019630-1 | NY | Primary |
Addresses
Primary practice location
513 Ogden Ave
Teaneck, NJ 07666-2935
Mailing address
513 Ogden Ave
Teaneck, NJ 07666-2935
Phone (917) 570-7472
Other names 1
- Michelle Ilene Gitlitz
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 |
|---|---|---|---|
| 019630-1 | NY | MD | Massage Therapist |
| 019630 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348790400000",
"number": "1972854016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "513 OGDEN AVE",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076662935",
"telephone_number": "917-570-7472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "513 OGDEN AVE",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076662935",
"telephone_number": "917-570-7472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUPKIN",
"first_name": "MICHELLE",
"middle_name": "ILENE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-28",
"last_updated": "2012-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "019630-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MICHELLE",
"last_name": "GITLITZ",
"middle_name": "ILENE",
"credential": "PH.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Teaneck, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.