Healthcare Provider Details

I. General information

NPI: 1902947393
Provider Name (Legal Business Name): JEFFREY HUTTERER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10326 68TH RD
FOREST HILLS NY
11375
US

IV. Provider business mailing address

6735 HARROW ST
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-3330
  • Fax: 718-897-0095
Mailing address:
  • Phone: 718-793-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007303
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: