JIMMY K MASTER


Address: 100 Nicolls Rd, Stony Brook, NY 11794-0001
Phone: 6316329510

JIMMY K MASTER (NPI# 1164079802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1164079802
Entity Type Individual
Full Name JIMMY K MASTER
Credential PSYD
Practice Address 100 Nicolls Rd
Stony Brook
NY 11794-0001
Mailing Address Po Box 1554
Stony Brook
NY 11790-0988
Practice Telephone 6316329510
Practice Fax Number 6316325870
Mailing Telephone 6314442990
Enumeration Date 2019-08-19
Last Update Date 2019-08-19
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TC0700X Psychologist
Specialization: Clinical 		P13072 NY Behavioral Health & Social Service Providers

Office Location

Street Address 100 NICOLLS RD
City STONY BROOK
State NY
Zip Code 11794-0001

Providers in the same location

NPI Name Taxonomy Address Enumeration
1356335640 Laura J Monahan Pediatrics 100 Nicolls Rd, Level 11, Suite 040, Stony Brook, NY 11794-8111 2005-09-01
1386250447 Farhana Zahan Nurse Practitioner 100 Nicolls Rd, Stony Brook, NY 11794-3627 2020-09-23
1003433509 Joseph Anthony Poppa Physician Assistant 100 Nicolls Rd, Stony Brook, NY 11794-3112 2020-06-30
1861027393 Joshua Nuval Student in an Organized Health Care Education/Training Program 100 Nicolls Rd, Stony Brook, NY 11794-0001 2020-03-04
1548894306 Matthew Messick Student in an Organized Health Care Education/Training Program 100 Nicolls Rd, Stony Brook, NY 11794-0001 2020-03-02
1386278133 Savannah Peters Student in an Organized Health Care Education/Training Program 100 Nicolls Rd, Stony Brook, NY 11794-4140 2020-03-01
1750915252 Hannah Skylar Palau Student in an Organized Health Care Education/Training Program 100 Nicolls Rd, Stony Brook, NY 11794-0001 2020-02-24
1609412741 Thomas Banks Physician Assistant 100 Nicolls Rd, Stony Brook, NY 11790-3407 2019-11-25
1083278972 Sara Khan Student in an Organized Health Care Education/Training Program 100 Nicolls Rd, Stony Brook, NY 11794-0001 2019-04-25
1376106468 Amber Michelle Bruckner Student in an Organized Health Care Education/Training Program 100 Nicolls Rd, Stony Brook, NY 11794-0001 2019-04-15
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1619506714 Ryan John Kottmeier Physician Assistant 101 Nicolls Road Suny Stony Brook Hospital, Dept of Orthopedics Hsc T18, Room 080, Stony Brook, NY 11794 2020-04-02
1699302109 Michael Trentalange Student in an Organized Health Care Education/Training Program Department of Surgery, Health Sciences Center Level 19, Room 030, Stony Brook, NY 11794 2020-03-25
1164985156 Lauren Kate Harris Student in an Organized Health Care Education/Training Program Stony Brook Medicine, Department of Ob/gyn, Hsc T9, 101 Nicolls Road, Stony Brook, NY 11794 2019-04-08
1851851448 Kathy Tin Student in an Organized Health Care Education/Training Program Dept of Medicine Hsc 16 Suny Stony Brook Hospital, Stony Brook, NY 11794 2019-03-21
1174083703 Arham Khan Student in an Organized Health Care Education/Training Program Dept of Medicine Hsc Level 16, Suny Stony Brook Hosp, Stony Brook, NY 11794 2019-03-20
1396221982 Aman Bhojani Student in an Organized Health Care Education/Training Program Suny At Stony Brook Dental School, South Drive, Stony Brook, NY 11794 2018-07-17
1699265629 Belliny Phaeton Student in an Organized Health Care Education/Training Program Stony Brook Children's Hospital, Hsc T-11, Room 040, Stony Brook, NY 11794 2018-05-15
1629568969 Rachel Herold Student in an Organized Health Care Education/Training Program Stony Brook Children's Department of Pediatrics, Hsc T-11, Room 040, Stony Brook, NY 11794 2018-05-11
1598254419 Nora Ann Diraimondo Nurse Practitioner Sb Hospital 101 Nicolls Road, Department of Medicine, Stony Brook, NY 11794 2018-05-07
1386140705 Ryan Christopher Corn Student in an Organized Health Care Education/Training Program Dept. of Internal Medicine, Hsc Level 16-020, Suny Stony Brook, Stony Brook, NY 11794 2018-04-04
Find all providers in zip 11794

Taxonomy Information

Taxonomy Code 103TC0700X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1760889661 Brittain Mahaffey Psychologist Suny Putnam Hl, Stony Brook, NY 11794-8790 2014-11-21
1407294580 Genna Faith Popovich Hymowitz Psychologist 469 Psychology Bldg B, Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2520 2013-06-11
1124338017 Veronique Regina Deutsch-anzalone Psychologist 100 Nicolls Rd Dept Of, Stony Brook, NY 11794-0012 2010-10-14
1124217195 John G. Cottone, Psychologist, Pllc Psychologist 1099 N Country Rd, Suite L, Stony Brook, NY 11790-1924 2007-10-16
1285829689 Bethany Clarke Riddle Psychologist 100 Nicholls Rd., Stony Brook, NY 11790-3100 2007-09-09
1053513317 Joanne Davila Psychologist 79 Christian Ave, Stony Brook, NY 11790-1201 2007-05-31
1396887733 John Gregory Cottone Psychologist 1099 North Country Rd, Suite L, Stony Brook, NY 11790-1999 2007-02-13
1417097247 Carol Harriet Sprafkin Psychologist 207 Hallock Road, Suite 204, Stony Brook, NY 11790 2007-02-08
1518013895 Brett M. Liquori Psychologist 12 Westwood Ave, Stony Brook, NY 11790-2837 2007-01-26
1407914518 Anne Virginia Peterson Psychologist Stadium Rd, 235 Counseling Ctr, Stony Brook, NY 11794-3100 2006-12-04
Find all providers in STONY BROOK

Competitor

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City STONY BROOK
Zip Code 11794

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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