MEDICARE: DR. JAMES MICHAEL MACCHIA 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
1	103TC0700X	Clinical Psychologist	026779	NY

General Provider Information

NPI Number	:	1871312892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL MACCHIA PHD

Provider Business Mailing Address
First Line	:	1430 BROADWAY RM 1102
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-9201
Country	:	US
Telephone Number	:	347-201-2290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 BROADWAY RM 1102
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-9201
Country	:	US
Telephone Number	:	347-201-2290
Fax Number	:

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

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/08/2024

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