MEDICARE: DR. SAMUEL SAUL KUPIETZ 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	103T00000X	Psychologist	4054	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	:	1508854480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL SAUL KUPIETZ PH.D

Provider Business Mailing Address
First Line	:	431 WEAVER ST
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-1301
Country	:	US
Telephone Number	:	914-833-2949
Fax Number	:	914-833-2949

Provider Business Practice Location Address
First Line	:	431 WEAVER ST
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-1301
Country	:	US
Telephone Number	:	914-833-2949
Fax Number	:	914-833-2949

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/09/2007

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