DR. MICHAEL LEONARD NISSENBAUM PH.D.
NPI 1174546725
Psychologist - Cognitive & Behavioral in Centereach, NY

Q: What is Michael Nissenbaum's NPI number?

The NPI number for Michael Nissenbaum is 1174546725. It was assigned to this individual provider in the NPPES registry on July 25, 2006.

Q: What is Michael Nissenbaum's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Cognitive & Behavioral, with taxonomy code 103TB0200X.

Active since July 25, 2006PECOS EnrolledAccepts Medicare Assignment

2100 MIDDLE COUNTRY RD, SUITE 28W, CENTEREACH, NY 11720(631) 737-9500(631) 737-9512 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Michael Leonard Nissenbaum Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MICHAEL LEONARD NISSENBAUM PH.D. (NPI 1174546725) is an individual cognitive & behavioral provider in Centereach, New York, licensed in New York (010232) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1988).

NPPES Registry Identity

NPI1174546725

Entity TypeIndividualMale

Primary Taxonomy103TB0200X

Provider Legal NameDR. MICHAEL LEONARD NISSENBAUMCredential: PH.D.

Location Address2100 MIDDLE COUNTRY RD, SUITE 28WCentereach, NY 11720-3577

Mailing AddressPo Box 625Centereach, NY 11720-0625 · (631) 737-9500 · Fax (631) 737-9512

Phone(631) 737-9500

Fax(631) 737-9512

Sole ProprietorYes

Medical School CMSOtherGraduated 1988

Enumeration DateJuly 25, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1174546725 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Cognitive & BehavioralBehavioral Health & Social Service Providers

Taxonomy Code103TB0200X

License✔ Licensed in NY · 010232

Definition

A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking.

2100 MIDDLE COUNTRY RD, Centereach, NY 11720

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Other Identifiers 2

Medicare ID-Type UnspecifiedV71171NY · Provider Number

Medicare UPINR-53044NY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Michael Leonard Nissenbaum Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2264336296

PECOS Enrollment IDI20031121000443

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HONEST PHYSICAL THERAPY PLLC

Physical Therapist (Orthopedic)

2100 MIDDLE COUNTRY RD, SUITE 17 LOWER LEVEL
CENTEREACH, NY 11720

Suffolk County (631) 504-0680

AIMEE WERNER

Physical Therapist