MEDICARE: DR. JANE ELLEN GARTNER 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	004403-1	NY

General Provider Information

NPI Number	:	1497878763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE ELLEN GARTNER PH.D.

Provider Business Mailing Address
First Line	:	552 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2608
Country	:	US
Telephone Number	:	718-499-3231
Fax Number	:	718-499-3231

Provider Business Practice Location Address
First Line	:	552 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2608
Country	:	US
Telephone Number	:	718-499-3231
Fax Number	:	718-499-3231

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	09/22/2010

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