MEDICARE: EILEEN RENEE WACHTER MD

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	2084P0800X	Psychiatry Physician	172576	NY

General Provider Information

NPI Number	:	1215001623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN RENEE WACHTER MD

Provider Business Mailing Address
First Line	:	219 E 69TH ST
Second Line	:	SUITE 1H
City	:	NEW YORK
State	:	NY
Zip	:	10021-5452
Country	:	US
Telephone Number	:	212-439-6328
Fax Number	:	212-439-6328

Provider Business Practice Location Address
First Line	:	219 E 69TH ST
Second Line	:	SUITE 1H
City	:	NEW YORK
State	:	NY
Zip	:	10021-5452
Country	:	US
Telephone Number	:	212-439-6328
Fax Number	:	212-439-6328

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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