MEDICARE: DR. ELAINE H. TULIS PH.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	6469-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0022639	OTHER	NY	GHI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235207580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE H. TULIS PH.D.

Provider Business Mailing Address
First Line	:	21 GRAY ROCK LN
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-2511
Country	:	US
Telephone Number	:	914-238-5359
Fax Number	:	914-238-5359

Provider Business Practice Location Address
First Line	:	21 GRAY ROCK LN
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-2511
Country	:	US
Telephone Number	:	914-238-5359
Fax Number	:	914-238-5359

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

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	07/09/2007

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