MEDICARE: DR. DENNIS YALE WILBUR 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	8494	NY

General Provider Information

NPI Number	:	1427135003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS YALE WILBUR PH.D.

Provider Business Mailing Address
First Line	:	2014 NEW YORK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4824
Country	:	US
Telephone Number	:	718-258-1046
Fax Number	:	718-758-7640

Provider Business Practice Location Address
First Line	:	2014 NEW YORK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4824
Country	:	US
Telephone Number	:	718-258-1046
Fax Number	:	718-854-5495

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/16/2007

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