MEDICARE: DR. JAY DAVIDOWITZ 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	005580	NY

General Provider Information

NPI Number	:	1720291446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY DAVIDOWITZ PH.D.

Provider Business Mailing Address
First Line	:	17 RIVER VIEW LN
Second Line	:
City	:	WOODBURY
State	:	CT
Zip	:	06798-2700
Country	:	US
Telephone Number	:	845-279-2995
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 DOANSBURG RD
Second Line	:	BOX 719
City	:	BREWSTER
State	:	NY
Zip	:	10509-0719
Country	:	US
Telephone Number	:	845-279-2995
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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