MEDICARE: DR. EVAN SCHWALBE 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	017479	NY

General Provider Information

NPI Number	:	1861676603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN SCHWALBE PH.D

Provider Business Mailing Address
First Line	:	353 LEXINGTON AVE
Second Line	:	1004
City	:	NEW YORK
State	:	NY
Zip	:	10016-0941
Country	:	US
Telephone Number	:	917-405-1329
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 LEXINGTON AVE
Second Line	:	1004
City	:	NEW YORK
State	:	NY
Zip	:	10016-0941
Country	:	US
Telephone Number	:	917-405-1329
Fax Number	:

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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