Healthcare Provider Details

I. General information

NPI: 1366897134
Provider Name (Legal Business Name): GREY MATTER NEUROPSYCHOLOGY OF NEW YORK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E 8TH ST SUITE 348
NEW YORK NY
10003-5901
US

IV. Provider business mailing address

9 E 8TH ST SUITE 348
NEW YORK NY
10003-5901
US

V. Phone/Fax

Practice location:
  • Phone: 646-543-4467
  • Fax: 646-304-8186
Mailing address:
  • Phone: 646-543-4467
  • Fax: 646-304-8186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number020276
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number020276
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number020276
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number020276
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020276
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number020276
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number020276
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number020276
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL R MEAGER
Title or Position: OWNER & FOUNDING DIRECTOR
Credential: PSY.D.
Phone: 646-543-4467