Healthcare Provider Details

I. General information

NPI: 1164848800
Provider Name (Legal Business Name): FREDERICK MUENCH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

254 6TH AVE APT 1
BROOKLYN NY
11215-2103
US

V. Phone/Fax

Practice location:
  • Phone: 212-974-0547
  • Fax:
Mailing address:
  • Phone: 917-532-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number019504
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: