MEDICARE: VERA KISHINEVSKY 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	103T00000X	Psychologist	015193-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015193-1	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1922214139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERA KISHINEVSKY PH.D

Provider Business Mailing Address
First Line	:	186 W 80TH ST
Second Line	:	SUITE 5J
City	:	NEW YORK
State	:	NY
Zip	:	10024-6317
Country	:	US
Telephone Number	:	646-852-7594
Fax Number	:

Provider Business Practice Location Address
First Line	:	186 W 80TH ST
Second Line	:	SUITE 5J
City	:	NEW YORK
State	:	NY
Zip	:	10024-6317
Country	:	US
Telephone Number	:	646-852-7594
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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