MEDICARE: DR. LEONID YAMPOLSKY 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	013244	NY

General Provider Information

NPI Number	:	1386759843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONID YAMPOLSKY PH.D.

Provider Business Mailing Address
First Line	:	6415 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3969
Country	:	US
Telephone Number	:	718-331-3800
Fax Number	:	718-331-3387

Provider Business Practice Location Address
First Line	:	6415 BAY PARKWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204
Country	:	US
Telephone Number	:	718-331-3800
Fax Number	:	718-331-3387

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	03/29/2014

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