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NPI Code Detail

MEDICARE: BRAD ALAN ARISOHN PHD

MEDICARE: BRAD ALAN ARISOHN PHD
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
1103TC0700XClinical Psychologist008520NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750327359
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD ALAN ARISOHN PHD
Provider Business Mailing Address
First Line : 4 CENTRAL AVE
Second Line :
City : ALBANY
State : NY
Zip : 12210-1334
Country : US
Telephone Number : 800-275-3243
Fax Number : 800-275-3671
Provider Business Practice Location Address
First Line : 4 CENTRAL AVE
Second Line :
City : ALBANY
State : NY
Zip : 12210-1334
Country : US
Telephone Number : 800-275-3243
Fax Number : 800-275-3671
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 01/17/2008

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