MEDICARE: DR. JAMES GRIES PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	015725-1	NY

General Provider Information

NPI Number	:	1033166434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES GRIES PSY.D.

Provider Business Mailing Address
First Line	:	475 MACATEE PL
Second Line	:
City	:	MINEOLA
State	:	NY
Zip	:	11501-1327
Country	:	US
Telephone Number	:	917-698-8161
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 SOUTH ST
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1714
Country	:	US
Telephone Number	:	516-669-0273
Fax Number	:	516-385-1573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	08/19/2016

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