MEDICARE: DR. RUTH M SHAFFER 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	010971-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386632446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUTH M SHAFFER PH.D.

Provider Business Mailing Address
First Line	:	6746 161ST ST
Second Line	:	APT 3A
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-3111
Country	:	US
Telephone Number	:	917-295-6099
Fax Number	:	718-904-7006

Provider Business Practice Location Address
First Line	:	1150 COMMONWEALTH AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-4603
Country	:	US
Telephone Number	:	718-904-7036
Fax Number	:	718-904-7024

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	10/28/2016

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