DR. MARK SANDBERG (NPI# 1831191709) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831191709 |
| Entity Type | Individual |
| Full Name | DR. MARK SANDBERG |
| Practice Address |
200 Belle Terre Rd Port Jefferson NY 11777-1928 |
| Practice Telephone | 6314746000 |
| Mailing Telephone | 6314746000 |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 010083 | NY | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316486731 | Mark Sandberg | Counselor | 118 E Jefferson St, Viroqua, WI 54665-1613 | 2017-02-17 |
| Street Address |
200 BELLE TERRE RD |
| City | PORT JEFFERSON |
| State | NY |
| Zip Code | 11777-1928 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346243987 | Stacey Luise Tursi | Nurse Practitioner | 200 Belle Terre Rd, Dept. of Nursing Education, Port Jefferson, NY 11777 | 2005-05-27 |
| 1114555331 | Justine Morgan | Occupational Therapist | 200 Belle Terre Rd, Port Jefferson, NY 11777-1968 | 2020-04-01 |
| 1013543503 | Michelle Wah | Student in an Organized Health Care Education/Training Program | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2020-03-17 |
| 1285266130 | James Joseph Cassin | Student in an Organized Health Care Education/Training Program | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2020-02-09 |
| 1518599752 | Yigit Ali Gol | Student in an Organized Health Care Education/Training Program | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2020-02-05 |
| 1043855596 | Robert Kennedy Awadallah | Pharmacist | 200 Belle Terre Rd, Port Jefferson, NY 11777-1968 | 2019-11-07 |
| 1356983449 | Joseph Francis Byrne | Physician Assistant | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2019-10-10 |
| 1871149740 | Alyssa Dawn Morando | Dietitian, Registered | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2019-08-15 |
| 1912562133 | Cassandra Jones | Anesthesiology | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2019-05-02 |
| 1235697400 | Joshua Jihun Sok | Student in an Organized Health Care Education/Training Program | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2019-03-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568088615 | Aqsa Ashraf | Student in an Organized Health Care Education/Training Program | 75 N Country Road Mather Hospital Internal Medicine Res, Port Jefferson, NY 11777 | 2020-06-24 |
| 1366068975 | Manal Ahmad | Student in an Organized Health Care Education/Training Program | 75 N County Rd, Level 2 Cmo Suite, Internal Medicine Re, Mather Hospital, Port Jefferson, NY 11777 | 2020-06-19 |
| 1639794555 | Umair Ahmad Ansari | Student in an Organized Health Care Education/Training Program | 75 N Country Road Mother Hospital, Internal Medicine Re, Level 2 - Cmd Suite, Port Jefferson, NY 11777 | 2020-06-16 |
| 1578188132 | Manasi Sule | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Mather Hospital, Internal Medicine Res, Port Jefferson, NY 11777 | 2020-06-10 |
| 1508480716 | Imona Subedi | Student in an Organized Health Care Education/Training Program | 75 N Country Road, Level 2 - Cmo Suite, Mather Hospital Internal Medicine Residency Program, Port Jefferson, NY 11777 | 2020-06-03 |
| 1184252108 | Romana Imtiaz Syed | Student in an Organized Health Care Education/Training Program | Liza M Dominioni,mather Hospital,internal Medicine, Residency Program,level 2-cmo Suite,75 N Country Rd, Port Jefferson, NY 11777 | 2020-03-27 |
| 1649807348 | Mustafa Mohammed Abdulsada | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Ny, Level 2 - Cmo Suite, Port Jefferson, NY 11777 | 2020-03-24 |
| 1184264764 | Girma Moges Gamme | Surgery | 625 Belle Terre Rd, Suite 203 Mather Hospital, Port Jefferson, NY 11777 | 2020-01-10 |
| 1811554637 | Kausar Ali | Nurse Practitioner | 408 Thompson Street, Port Jefferson, NY 11777 | 2019-05-28 |
| 1073097531 | Ministry for Hope, Inc. Montfort Therapeutic Residence | Residential Treatment Facility, Physical Disabilities | 100 Stonyhill Road, Port Jefferson, NY 11777 | 2018-09-20 |
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| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114437241 | Sara Nicole Resch | Clinical Neuropsychologist | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2017-10-03 |
| 1225457765 | Jacqueline Lobosco | Clinical Neuropsychologist | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2014-04-14 |
| 1699742577 | Michael J Parrella | Clinical Neuropsychologist | 646 Main St, Port Jefferson, NY 11777-2235 | 2006-03-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609408046 | Nassau Neuropsychological Services, Pllc | Clinical Neuropsychologist | 386 S Oyster Bay Rd, Hicksville, NY 11801-3509 | 2020-02-04 |
| 1922656875 | Kouros Emami | Clinical Neuropsychologist | 525 East 71st St., 5th Floor, New York, NY 10021 | 2019-09-03 |
| 1720633860 | Emily Kurlansik | Clinical Neuropsychologist | 300 W 55th St Apt 6c, New York, NY 10019-5164 | 2019-08-06 |
| 1174181382 | Kayla Whearty | Clinical Neuropsychologist | 1554 Northern Blvd Ste 204, Manhasset, NY 11030-3054 | 2019-06-03 |
| 1447729595 | Beth Krone | Clinical Neuropsychologist | 6818 Bay Cliff Ter, Brooklyn, NY 11220-5114 | 2018-11-19 |
| 1750860144 | Linda Cristina Calderon | Clinical Neuropsychologist | 635 W 165th St Rm 633a, New York, NY 10032-3724 | 2018-08-07 |
| 1366936585 | Nicole Feirsen | Clinical Neuropsychologist | 3307 Bainbridge Ave Fl 1, Bronx, NY 10467-2850 | 2018-06-20 |
| 1306349493 | Abhishek Jaywant | Clinical Neuropsychologist | 525 E 68th St # F-1699g, New York, NY 10065-4870 | 2018-03-14 |
| 1043718505 | Elsa Lee | Clinical Neuropsychologist | 25418 Northern Blvd Ste 3, Little Neck, NY 11362-1451 | 2018-01-30 |
| 1154829000 | Alice Brown Brandwein | Clinical Neuropsychologist | 445 Park Ave Fl 2, New York, NY 10022-8649 | 2018-01-25 |
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| City | PORT JEFFERSON |
| Zip Code | 11777 |
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| 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.