Healthcare Provider Details

I. General information

NPI: 1053611921
Provider Name (Legal Business Name): MIGUELINA GERMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

250 FORT WASHINGTON AVE APT 1D
NEW YORK NY
10032-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-991-0605
  • Fax: 718-991-2931
Mailing address:
  • Phone: 480-760-5387
  • Fax: 717-991-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number018850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: