MEDICARE: DAVID I DORON 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	010672-1	NY

General Provider Information

NPI Number	:	1275753105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID I DORON PH.D.

Provider Business Mailing Address
First Line	:	10923 71ST RD
Second Line	:	SUITE 1-C
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4849
Country	:	US
Telephone Number	:	718-544-7903
Fax Number	:	718-544-1980

Provider Business Practice Location Address
First Line	:	10923 71ST RD
Second Line	:	SUITE 1-C
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4849
Country	:	US
Telephone Number	:	718-544-7903
Fax Number	:	718-544-1980

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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