MEDICARE: DR. JONI WEINSTOCK 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	012956	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2558908	OTHER		OXFORD

General Provider Information

NPI Number	:	1942280615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONI WEINSTOCK PHD

Provider Business Mailing Address
First Line	:	239 N BROADWAY
Second Line	:	SUITE SIX
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2674
Country	:	US
Telephone Number	:	914-591-7989
Fax Number	:	914-591-7989

Provider Business Practice Location Address
First Line	:	239 N BROADWAY
Second Line	:	SUITE SIX
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2674
Country	:	US
Telephone Number	:	914-591-7989
Fax Number	:	914-591-7989

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/15/2017

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