MEDICARE: MR. JOSEPH SOLANO

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

General Provider Information

NPI Number	:	1902954753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH SOLANO

Provider Business Mailing Address
First Line	:	55 MCKINLEY AVE
Second Line	:	APT. D1-6
City	:	WHITE PLAINS
State	:	NY
Zip	:	10606-1646
Country	:	US
Telephone Number	:	917-584-3525
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 E 92ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-1448
Country	:	US
Telephone Number	:	718-778-5927
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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